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Burn F, Schirpenbach C, Bidlingmaier M, Reincke M, Vetter D, Weishaupt D, Brockmann JG, Müller MK, Weber M, Dahm F, Nocito A. Left-Sided Living Kidney Donation Leads to Transiently Reduced Adrenocortical Responsiveness. Am J Transplant 2017; 17:1879-1884. [PMID: 28024112 DOI: 10.1111/ajt.14184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/28/2016] [Accepted: 12/19/2016] [Indexed: 01/25/2023]
Abstract
Living kidney donation is safe and established, but can lead to long-term complications such as chronic fatigue. Since the adrenal vein is usually transected during left-sided donor nephrectomy-which is not necessary on the right-we hypothesized that venous congestion might lead to an impairment of adrenal function, offering a possible explanation. In this prospective open label, monocentric cohort study, adrenal function was compared in left- and right-sided living kidney donors. The primary endpoint was plasma cortisol response to low-dose adrenocorticotropic hormone (ACTH) stimulation. Secondary endpoints included plasma renin and ACTH concentration as well as adrenal volume in response to donor nephrectomy. A total of 30 healthy donors-20 left- and 10 right-sided donations-were included. On postoperative day 1, response to low-dose ACTH stimulation was intact, but significantly lower after left-sided donor nephrectomy. After 28 days, adrenal responsiveness to ACTH stimulation did not differ any longer. Magnetic resonance imaging volumetry showed no significant adrenal volume change over 4 weeks, neither after left- nor after right-sided nephrectomy. In conclusion, left-sided living kidney donation entails a transiently reduced adrenocortical responsiveness, which returns to baseline after 28 days.
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Affiliation(s)
- F Burn
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - C Schirpenbach
- Division of Endocrinology, Department of Internal Medicine, University Hospital Munich, Munich, Germany
| | - M Bidlingmaier
- Division of Endocrinology, Department of Internal Medicine, University Hospital Munich, Munich, Germany
| | - M Reincke
- Division of Endocrinology, Department of Internal Medicine, University Hospital Munich, Munich, Germany
| | - D Vetter
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - D Weishaupt
- Department of Radiology and Nuclear Medicine, Triemli Hospital Zurich, Zurich, Switzerland
| | - J G Brockmann
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - M K Müller
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Surgery, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - M Weber
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Surgery, Triemli Hospital Zurich, Zurich, Switzerland
| | - F Dahm
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - A Nocito
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Surgery, Cantonal Hospital Baden, Baden, Switzerland
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Abstract
OBJECTIVE To compare single women, lesbian couples, and heterosexual couples receiving therapeutic donor insemination (TDI). DESIGN Chart review followed by anonymous mail questionnaires to donor insemination recipients and their partners. SETTING Infertility clinic in a university hospital. PATIENTS One hundred fifteen women receiving donor insemination were identified by chart review. RESULTS Too few single women responded for reliable comparison. Lesbian women were similar to married women in age, education, duration, and outcome of donor insemination. When considering alternatives to TDI, married women were more likely to consider adoption and lesbians were most likely to consider using a known semen donor or having intercourse with a man aware of their desire to have a child. Married couples were less likely to tell others, including the child, about conception by donor insemination. They were also less likely to support disclosing identifying data about the donor to the child. Lesbians were more likely to report stress in their relationships as a result of TDI. Married men were most likely to support mandatory counseling before TDI initiation.
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