Risk factors and 2 year outcomes of low estimated glomerular filtration rate in the immediate post-operative period for living kidney donors
Pahari H, Nagai S, Takahashi K, Tinney F, Denny J, Malinzak L, Rizzari M, Collins K, Yoshida A, Abouljoud MS, Kim D. Risk factors and 2 year outcomes of low estimated glomerular filtration rate in the immediate post-operative period for living kidney donors. Am J Transplant 2017; 17:495.
Am J Transplant
Background: While long-term risk of end-stage renal disease in living kidney donors is considered less than 0.25% at 15 years, an association between the immediate post-operative estimated GFR and long-term outcomes after donor nephrectomy remains to be elucidated. Methods: From April 2008 to June 2014, 186 consecutive living kidney donors were retrospectively evaluated. eGFR was calculated using MDRD-4 formula. Statistical analysis was done using logistic regression analysis. Results: The median eGFR on post-operative day 1 (eGFR1) was 51.8mL/ min/1.73m2. Risk factors for eGFR1<50mL/min/1.73m2 were age>50years (OR 5.31; p=0.0004) and pre-operative eGFR <100mL/min/1.73m2 (OR 9.96; p<0.0001). Protective factors for loss in eGFR<40% post donation were female sex (p=0.001) and lower pre-operative creatinine (p<0.0001) (Table presented). Correlation between post-op creatinine and creatinine at 2 years (n=114) was strongly positive (r=0.692; p<0.0001). Older age (p=0.002) was the only independent risk factor for higher loss of renal function at 2 years (LRF2y>50%). Median recovery of eGFR at 2 years (RRF2y) was 17% of the pre-eGFR. Higher age was an independent risk factor for RRF2y<15% (p=0.001) after multivariate analysis. Conclusions: Older donors (>50y) may have higher risk for renal dysfunction after nephrectomy and poorer long-term recovery, compared to younger donors. Older donors with pre-donation eGFR less than 100mL/min/1.73m2 should be used with caution.