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Kyaw L, Thandapani K, Tan L, Peng HM, Goh B, Lu J, Raman L, Tai BC, Anantharaman V, Tiong HY. Choosing the larger kidney on CT volumetry: a study on the early post-donation kidney function of living donors. Int Urol Nephrol 2024; 56:97-102. [PMID: 37653357 DOI: 10.1007/s11255-023-03737-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/06/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Selecting the smaller kidney for donation has been advocated if there is a size difference of > 10% between the 2 kidneys but has never been prospectively evaluated. With increase in donor nephrectomies, it is important to evaluate this to minimize loss of renal function to donors. METHODS 75 consecutive donor nephrectomy patients were included in our longitudinal study. The Split Renal Volume (SRV) of bilateral kidneys were measured using contrasted computer tomography scans and patients segregated into 2 groups depending on donated kidney having more (Group 1) or less than (Group 2) 52.5% of SRV. RESULTS Patients in Group 1 (n = 19) and 2 (n = 56) were of similar age (43.8 vs. 48.3), BMI (22.4 vs. 25.2), sex (57.9 vs. 55.4% women), respectively. Although total kidney volumes were similar in both groups, Group 1 had significantly smaller right kidney volumes (120.4 ± 24.9 vs. 142.7 ± 28.4 mls, p = 0.003). EGFR pre-operatively (116.3 ± 20.8 vs. 106.3 ± 23.8 mL/min/1.73 m2) and at 6-months (65.7 ± 13.3 vs. 66.9 ± 15.5 mL/min/1.73 m2) were not different between groups. However, patients in Group 1 had significantly greater absolute (50.6 ± 14.9 vs. 39.5 ± 14.7 mL/min/1.73 m2) and relative decline (43.0 ± 8.6 vs. 36.3 ± 10.6%) in eGFR at 6 months (p = 0.06, 0.009). CONCLUSION With a SRV difference of 5% between the 2 sides, removal of the larger kidney for living kidney donation resulted in greater early decline of renal function than kidney donors whose larger or equivalent kidney is preserved.
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Affiliation(s)
- Lin Kyaw
- Department of Urology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | | | - Lynnette Tan
- Department of Urology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Hong Min Peng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Goh
- Department of Urology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Centre for Organ Transplantation, Singapore, Singapore
| | - Jirong Lu
- Department of Urology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
- National University Centre for Organ Transplantation, Singapore, Singapore
| | - Lata Raman
- Department of Urology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Bee Choo Tai
- School of Public Health, National University Singapore, Singapore, Singapore
| | - Vathsala Anantharaman
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Centre for Organ Transplantation, Singapore, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- National University Centre for Organ Transplantation, Singapore, Singapore.
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Lee YH, Kim JS, Song SH, Song SH, Shin HS, Yang J, Ahn C, Jeong KH, Hwang HS. Impact of donor hypertension on graft survival and function in living and deceased donor kidney transplantation: a nationwide prospective cohort study. J Hypertens 2022; 40:2200-2209. [PMID: 36093867 DOI: 10.1097/hjh.0000000000003246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Hypertensive living donors are potential candidates to expand the kidney donor pool. However, the impact of donor hypertension on graft survival and function remains to be clarified. METHODS We analyzed 3907 kidney transplant recipients registered in a nationwide prospective cohort from 2014 to 2018. Patients were divided by donor types and the presence of donor hypertension. The primary and secondary outcome was the occurrence of death-censored graft failure and renal allograft function, respectively. RESULTS The prevalence of hypertension was 9.4% (258/2740) and 19.9% (232/1167) in living and deceased donors, respectively. During a median follow-up of 21.8 months, death-censored graft survival rate was significantly worse in recipients of hypertensive living donors than in those of normotensive living donors ( P = 0.008). In multivariable analysis, recipients of hypertensive living donors had a significantly increased risk of graft loss (adjusted hazard ratio 2.91; P = 0.009). The risk of allograft loss was not different between recipients of hypertensive living and normotensive deceased donors. Propensity score-matched analyses had consistent worse graft survival rate in recipients of hypertensive living donors compared to those of normotensive living donors ( P = 0.027), while it was not different between recipients of hypertensive living and normotensive deceased donors. Hypertension in living donors had a significant negative impact on one-year graft function (adjusted unstandardized β -3.64; P = 0.011). CONCLUSIONS Hypertensive living donor recipients have significantly higher risks of renal allograft loss than normotensive living donor recipients, and showed similar outcomes compared to recipients of normotensive deceased donors.
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Affiliation(s)
- Yu Ho Lee
- Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam
| | - Jin Sug Kim
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul
| | - Sang Heon Song
- Biomedical Research Institute, Department of Internal Medicine, Pusan National University Hospital, Busan
| | - Seung Hwan Song
- Department of Surgery, Ewha Womans University College of Medicine, Seoul
| | - Ho Sik Shin
- Department of Internal Medicine, Kosin University College of Medicine, Busan
| | - Jaeseok Yang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul
| | - Curie Ahn
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
| | - Kyung Hwan Jeong
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul
| | - Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul
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3
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Goh ET, Jalalonmuhali M, Ng KP, Wan Md Adnan AH, Hing (Wong) A, Cheng SF, Ooi SH, Gan CC. The Outcome of the Elderly Living Kidney Donors in a Single Tertiary Center in Malaysia. Transplant Proc 2022; 54:272-277. [DOI: 10.1016/j.transproceed.2021.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
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4
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Al Ammary F, Yu S, Muzaale AD, Segev DL, Liyanage L, Crews DC, Brennan DC, El-Meanawy A, Alqahtani S, Atta MG, Levan ML, Caffo BS, Welling PA, Massie AB. Long-term kidney function and survival in recipients of allografts from living kidney donors with hypertension: a national cohort study. Transpl Int 2021; 34:1530-1541. [PMID: 34129713 DOI: 10.1111/tri.13947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/08/2021] [Accepted: 06/06/2021] [Indexed: 12/27/2022]
Abstract
Allografts from living kidney donors with hypertension may carry subclinical kidney disease from the donor to the recipient and, thus, lead to adverse recipient outcomes. We examined eGFR trajectories and all-cause allograft failure in recipients from donors with versus without hypertension, using mixed-linear and Cox regression models stratified by donor age. We studied a US cohort from 1/1/2005 to 6/30/2017; 49 990 recipients of allografts from younger (<50 years old) donors including 597 with donor hypertension and 21 130 recipients of allografts from older (≥50 years old) donors including 1441 with donor hypertension. Donor hypertension was defined as documented predonation use of antihypertensive therapy. Among recipients from younger donors with versus without hypertension, the annual eGFR decline was -1.03 versus -0.53 ml/min/m2 (P = 0.002); 13-year allograft survival was 49.7% vs. 59.0% (adjusted allograft failure hazard ratio [aHR] 1.23; 95% CI 1.05-1.43; P = 0.009). Among recipients from older donors with versus without hypertension, the annual eGFR decline was -0.67 versus -0.66 ml/min/m2 (P = 0.9); 13-year allograft survival was 48.6% versus 52.6% (aHR 1.05; 95% CI 0.94-1.17; P = 0.4). In secondary analyses, our inferences remained similar for risk of death-censored allograft failure and mortality. Hypertension in younger, but not older, living kidney donors is associated with worse recipient outcomes.
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Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sile Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luckmini Liyanage
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deidra C Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel C Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashraf El-Meanawy
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Saleh Alqahtani
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohamed G Atta
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Macey L Levan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian S Caffo
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul A Welling
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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5
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Blood Pressure and Living Kidney Donors: A Clinical Perspective. Transplant Direct 2019; 5:e488. [PMID: 31723583 PMCID: PMC6791603 DOI: 10.1097/txd.0000000000000939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/09/2019] [Indexed: 01/13/2023] Open
Abstract
Elevated blood pressure (BP), or “hypertension,” has been one of the main exclusion criteria for living kidney donation, as it is a risk factor for renal and cardiovascular disease. The effect of elevated BP in living kidney donors is not well studied or understood. The most current living kidney donation guidelines state that donors with a BP >140/90 mm Hg with 1–2 antihypertensive medications or evidence of end-organ damage should be excluded from living kidney donation. Yet, the definitions of “hypertension” have changed with the release of the American Heart Association (AHA)/American College of Cardiology (ACC) clinical practice guidelines suggesting that 120–129 mm Hg is elevated BP and Stage 1 hypertension is 130 mm Hg. However, the kidney function (in terms of estimated GFR) of “hypertensive” living kidney donors does not fare significantly worse postdonation compared with that of “normotensive” donors. In addition, even though living kidney donation itself is not considered to be a risk factor for developing hypertension, there exist certain risk factors (African American or Hispanic descent, obesity, age) that may increase the risk of living kidney donors developing elevated BP postdonation. The choice of BP targets and medications needs to be carefully individualized. In general, a BP <130/80 mm Hg is needed, along with lifestyle modifications.
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Long term evolution of renal function in essential hypertensive patients with no baseline proteinuria. J Hum Hypertens 2019; 34:560-567. [PMID: 31477829 DOI: 10.1038/s41371-019-0245-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/16/2019] [Accepted: 05/24/2019] [Indexed: 11/08/2022]
Abstract
Data on the long term evolution of renal function in essential hypertensive patients are scarce, showing a low incidence of end stage renal diseases but without information on how the renal function evolves. Our aim is to describe the long term evolution of renal function and possible trajectories in hypertensive patients. We included patients from an ongoing cohort with essential hypertension, no proteinuria at baseline and no diabetes during follow-up and with at least two creatinine dosages 4 years apart. A long term (average 16 years) follow-up was available in 609 patients (baseline age 51.8 ± 11.1 years, 52 % male, mean office BP 156//95 mmHg). The trajectories of creatinine were modeled through a flexible latent class mixed model. The analysis identified three classes of significantly different trajectories. In the first (n = 560), there was no significant variation of creatinine over time. In the second (n = 40), there was a significant rise of creatinine (117 ± 20 vs 85 ± 17 µmol/l, p < 0.0001). The third class (n = 9) was very heterogeneous, mainly composed of outliers. Further analysis showed the nonlinearity of the evolution of creatinine in classes 2 and 3. So the model of progressive renal deterioration in essential hypertension does not fit with our results. A large majority (92%) of patients show no significant change in creatinine level with time. In the others 8%, the increase in creatinine is not progressive but conversely show one or more sudden bouts of elevation.
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Al Ammary F, Luo X, Muzaale AD, Massie AB, Crews DC, Waldram MM, Qadi MA, Garonzik-Wang J, Henderson ML, Brennan DC, Wiseman AC, Lindrooth RC, Snyder JJ, Coresh J, Segev DL. Risk of ESKD in Older Live Kidney Donors with Hypertension. Clin J Am Soc Nephrol 2019; 14:1048-1055. [PMID: 31239252 PMCID: PMC6625624 DOI: 10.2215/cjn.14031118] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Hypertension in older kidney donor candidates is viewed as safe. However, hypertension guidelines have evolved and long-term outcomes have not been explored. We sought to quantify the 15-year risk of ESKD and mortality in older donors (≥50 years old) with versus those without hypertension. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A United States cohort of 24,533 older donors from 1999 to 2016, including 2265 with predonation hypertension, were linked to Centers for Medicare and Medicaid Services data and the Social Security Death Master File to ascertain ESKD development and mortality. The exposure of interest was predonation hypertension. From 2004 to 2016, hypertension was defined as documented predonation use of antihypertensive therapy, regardless of systolic BP or diastolic BP; from 1999 to 2003, when there was no documentation of antihypertensive therapy, hypertension was defined as predonation systolic BP ≥140 or diastolic BP ≥90 mm Hg. RESULTS Older donors were 82% white, 6% black, 7% Hispanic, and 3% Asian. The median follow-up was 7.1 years (interquartile range, 3.4-11.1; maximum, 18). There were 24 ESKD and 252 death events during the study period. The 15-year risk of ESKD was 0.8% (95% confidence interval [95% CI], 0.4 to 1.6) for donors with hypertension (mean systolic BP, 138 mm Hg) versus 0.2% (95% CI, 0.1 to 0.4) for donors without hypertension (mean systolic BP, 123 mm Hg; adjusted hazard ratio, 3.04; 95% CI, 1.28 to 7.22; P=0.01). When predonation antihypertensive therapy was available, the risk of ESKD was 6.21-fold higher (95% CI, 1.20 to 32.17; P=0.03) for donors using antihypertensive therapy (mean systolic BP, 132 mm Hg) versus those not using antihypertensive therapy (mean systolic BP, 124 mm Hg). There was no significant association between donor hypertension and 15-year mortality (hazard ratio, 1.18; 95% CI, 0.84 to 1.66; P=0.34). CONCLUSIONS Compared with older donors without hypertension, older donors with hypertension had higher risk of ESKD, but not mortality, for 15 years postdonation. However, the absolute risk of ESKD was small.
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Affiliation(s)
| | - Xun Luo
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Allan B. Massie
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | - Madeleine M. Waldram
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | | | - Macey L. Henderson
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alexander C. Wiseman
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard C. Lindrooth
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado
| | - Jon J. Snyder
- Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota; and
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Josef Coresh
- Departments of Medicine and
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Dorry L. Segev
- Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
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Söğütdelen E, Yildirim T, Haberal HB, Canpolat U, Hazirolan T, Doğan HS, Yilmaz ŞR, Erdem Y, Aki FT. Donor Nephrectomy May Compromise the Cardiovascular System: A Retrospective, Single-Center Study. EXP CLIN TRANSPLANT 2018; 19:237-243. [PMID: 30084761 DOI: 10.6002/ect.2018.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our goal was to determine the short-term effects of donor nephrectomy on the cardiovascular system and to gain a better understanding of the recently recognized long-term increased risk of end-stage renal disease and cardiovascular mortality. MATERIALS AND METHODS Living kidney donors who underwent donor nephrectomy between January 2010 and January 2015 at the Hacettepe University Transplantation Unit were retrospectively screened. Echocardiographic parameters, kidney volumes, and renal functions before nephrectomy were compared with measurements after nephrectomy. Flow-mediated dilatation values of living kidney donors were compared with healthy individuals. RESULTS The study included 73 female and 31 male living kidney donors with a mean age of 46.1 ± 10.8 years. In the comparative analysis of donors versus 35 healthy individuals, the changes in flow-mediated dilatation were 12.3 ± 5.7% and 15.4 ± 6.3%, respectively (P = .016). In the comparative analysis of preoperative versus the last visit transthoracic echocardiographic results, left ventricular end-systolic and end-diastolic diameters decreased and left ventricular posterior wall thickness and septum thickness increased (P = .025, P = .002, P = .026, and P = .019, respectively). CONCLUSIONS Nephrectomy may cause several hemodynamic changes in living kidney donors, which may exacerbate cardiovascular risks in this population.
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Affiliation(s)
- Emrullah Söğütdelen
- From the Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Cohen J, Owei L, Sawinski D, Porrett P. Inferior long-term allograft and patient outcomes among recipients of offspring living donor kidneys. Am J Transplant 2018; 18:1699-1709. [PMID: 29266831 PMCID: PMC6013327 DOI: 10.1111/ajt.14631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/07/2017] [Accepted: 12/12/2017] [Indexed: 01/25/2023]
Abstract
While offspring-to-parent living donor kidney transplantations may represent an ideal donor-recipient combination to optimize long-term transplantation outcomes, the sex-specific long-term success of these transplantations remains unclear. We hypothesize that allograft and recipient survivals in offspring-to-parent living donor kidney transplantation differ between men and women due to donor-specific alloimmunization during pregnancy. We retrospectively analyzed long-term allograft and patient survival among men and women who received an offspring living donor kidney compared with those who received other haplotype-matched living donor kidneys. Based on multivariable Cox proportional hazards modeling of Organ Procurement and Transplantation Network data from 2001 to 2015, we found that both men and women who received offspring living donor kidneys had significantly increased mortality compared with recipients who received nonoffspring living donor kidneys. While male recipients of any living donor kidney had greater risk of mortality and allograft failure than female recipients, there was no significant difference in all-cause allograft failure or mortality in male versus female recipients of offspring living donor kidney transplantations. Our analysis demonstrated no significant interaction between recipient sex and donor offspring status. We conclude that nonoffspring living donors should be considered whenever feasible for both men and women with multiple donor options.
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Affiliation(s)
- J.B. Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - L. Owei
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D.L. Sawinski
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - P.M. Porrett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Division of Transplant Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Abdominal Aortic Calcification in Living Kidney Donors. Transplant Proc 2017; 48:720-4. [PMID: 27234721 DOI: 10.1016/j.transproceed.2016.02.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/30/2016] [Accepted: 02/18/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study assesses the association between abdominal aortic calcification (AAC) and renal function of living kidney donors and evaluate AAC as a surrogate marker for nephrosclerosis. METHODS Between January 2010 and March 2013, 287 donors who underwent living donor nephrectomy were enrolled. We analyzed computed tomography angiographies and quantified AAC scores by calculating the Agatston score for the abdominal aorta. The donors were stratified into the non-AAC group (AAC score = 0; n = 238) and the AAC group (AAC score >0; n = 49). The relationship between AAC and perioperative estimated glomerular filtration rate was analyzed. For the 180 donors consenting to implantation biopsy, the nephrosclerosis score was defined as the sum of abnormalities, including glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arteriosclerosis. RESULTS The mean AAC score was 185.5 ± 263.3 in the AAC group. The AAC group was older than the non-AAC group (51.1 ± 6.1 vs 37.9 ± 11 years; P < .001). Perioperative renal function was not different between the 2 groups. However, among the AAC group, donors with an AAC score of >100 were associated with delayed renal function recovery (P = .035). Donors with AAC were more likely to have glomerulosclerosis (50.0% vs 29.1%; P = .022), tubular atrophy (62.5% vs 33.1%; P = .002), and a higher nephrosclerosis score (P = .002). CONCLUSIONS Living donors with an AAC score of >100 require close observation because they have a higher probability of delayed renal function recovery after donation. AAC is associated with nephrosclerosis in healthy adults.
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