Association of mGFR of the Remaining Kidney Divided by Its Volume before Donation with Functional Gain in mGFR among Living Kidney Donors

Courbebaisse, Marie; Tissier, Anne-Marie; Fournier, Catherine; Nestour, Alexis Le; Corréas, Jean-Michel; Slimani-Thevenet, Hind; Martinez, Frank; Léon, Carine; Eladari, Dominique; Timsit, Marc‐Olivier; Otal, Philippe; Hignette, C.; Friedlander, Gérard; Méjean, A.; Houillier, Pascal; Kamar, Nassim; Legendre, Christophe

doi:10.2215/cjn.12731215

Cited by 19 publications

(15 citation statements)

References 31 publications

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“…This observation is in accordance with what was reported regarding the relationship between eGFR and mGFR among potential donors [19]. Moreover, we recently published two studies showing that mGFR (and not eGFR) divided by the volume of the remaining kidney could be used to predict functional gain of the remaining kidney following donation [20] and that measured GFR could not be predicted precisely by calculators or equations for nearly 60% of donors [19]. For these reasons, we think that eGFR cannot replace mGFR in living donor screening.…”

Section: Discussionsupporting

confidence: 92%

What is the significance of end-stage renal disease risk estimation in living kidney donors?

et al. 2017

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Two end-stage renal disease (ESRD) risk calculators were recently developed by Grams et al., and Ibrahim et al. to calculate ESRD risk before donation among living kidney donors. However, those calculators have never been studied among potential donors for whom donation was refused due to medical contraindications and compared to a group of donors. We compared 15-year and lifetime ESRD risk of donors and nondonors due to medical cause as estimated by those two calculators. Nondonors due to medical cause (n = 27) had a significantly higher 15-year ESRD risk compared to donors (n = 288) with both calculators (0.25 vs. 0.14, P < 0.001 for that developed by Grams et al. and 2.21 vs. 1.43, P = 0.002 for that developed by Ibrahim et al.). On the contrary, lifetime ESRD risk was not significantly different between the two groups. At both times (15 years and lifetime), we observed a significant overlap of ESRD risk between the two groups. ESRD risk calculators could be complementary to standard screening strategy but cannot be used alone to accept or decline donation.

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Section: Discussionsupporting

confidence: 92%

What is the significance of end-stage renal disease risk estimation in living kidney donors?

et al. 2017

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“…First, irrespective of age at donation, eGFR on average steadily increased for the subsequent few years (Figures 1 and 2 age and BMI at donation were inversely correlated with the change in GFR. 28 Similarly, we found that both age and BMI at donation, were inversely correlated with postdonation eGFR (Figure 2A). with our data, this information suggests that GFR increases for many years postdonation, and that once the age-related fall in GFR begins, donors have more reserve than population data might suggest.…”

Section: Discussionsupporting

confidence: 65%

“…Similarly, Lenihan et al, studying postdonation glomerular dynamics, reported increased plasma flow and GFR over 6 years (27). Although also finding an increase in measured GFR for the first 5 years after donation, Courbebaisse et al found that age and body mass index at donation were inversely correlated with the change in GFR (28). We found a similar association between both age at donation and BMI at donation, with postdonation eGFR.…”

Section: Discussionmentioning

confidence: 99%

“…-up, 25.8 years), there was a slower continuing increase in eGFR for younger donors; but for older donors (eg, ≥55 years old), GFR stabilized and then declined once the donor reached 70 years of age. An increasing eGFR in the first few years postdonation has previously been reported [25][26][27][28][29][30]. In a study with short follow-up, Cho et al, using serial 99 mTc-diethylenetriaminepentaacetic acid scans over 2 years postdonation, found increasing GFR 25.…”

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confidence: 84%

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GFR ≤25 years postdonation in living kidney donors with (vs. without) a first-degree relative with ESRD

Matas

Vock

Ibrahim

2018

American Journal of Transplantation

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An increased risk of ESRD has been reported for living kidney donors, and appears to be higher for those donating to a relative. The reasons for this are not clear. One possibility is that ESRD is due to the nephrectomy-related reduction in GFR, followed by an age-related decline that may be more rapid in related donors. Between 1/1/1990 and 12/31/2014, we did 2002 living donor nephrectomies. We compared long-term postdonation eGFR trajectory for donors with (n = 1245) vs. without (n = 757) a first-degree relative with ESRD. Linear mixed-effects models were used to model the longitudinal trajectory of eGFR. With all other variables held constant, we noted a steady average increase in eGFR until donors reached age 70: 1.12 (95% CI: 0.92-1.32) mL/min/1.73m /yr between 6 weeks and 5 years postdonation; 0.24 (0.00-0.49) mL/min/1.73m /yr between 5 and 10 years; and 0.07 (-0.10 to +0.25) mL/min/1.73m /yr between 10 and 20 years for donors with attained age less than 70. After age 70, eGFR declined. After we adjusted for predonation factors, the difference in eGFR slopes between related and unrelated donors was 0.20 mL/min/1.753 m /year (0.07-0.33). Our data suggests that postdonation, kidney donor eGFR increases each year for a number of years and that eGFR trajectory does not explain any increase in ESRD after donation.

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“…Fifty-eight articles received full-article screening. Of these, we excluded the following: 22 studies were not relevant; 10 studies only included patients with kidney disease (and not kidney donors); 24-33 4 studies did not report Pearson’s r and data could not be extracted; 34-37 and 1 study compared SRF with SRV in mL/min rather than as a percent and was inappropriate for pooling. 38 The 21 eligible studies are described in Table 1 and were mathematically combined in meta-analysis along with the results from the London, Ontario chart review.…”

Section: Resultsmentioning

confidence: 99%

Can Split Renal Volume Assessment by Computed Tomography Replace Nuclear Split Renal Function in Living Kidney Donor Evaluations? A Systematic Review and Meta-Analysis

Habbous

Garcia-Ochoa

Brahm

et al. 2019

Can J Kidney Health Dis

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Background: As part of their living kidney donor assessment, all living donor candidates complete a computed tomography (CT) angiogram, but some also receive a nuclear renogram for split renal function (SRF%). Objective: We considered whether split renal volume (SRV%) assessed by CT can predict SRF%. Design: Systematic review and meta-analysis. Setting: Living donor candidates undergoing evaluation as potential living kidney donors. Patients: Living donor candidates who received both a nuclear renogram for split function and CT for SRV as part of their living donor work-up. Measurements: Split renal volume from CT scans and SRF from nuclear renography. Methods: We performed a systematic review and meta-analysis of the literature, abstracting data and digitizing plots where possible. We searched Medline, EMBASE, and the Cochrane Library. We added data from donor candidates assessed in London, Ontario from 2013 to 2016. We used fixed and random-effects models to pool Fisher’s z-transformed Pearson’s correlation coefficient ( r). We conducted random-effects meta-regression on digitized and aggregate data. Studies were restricted to living kidney donors or living donor candidates. Results: After pooling 19 studies (n = 1479), we obtained a pooled correlation of r = 0.74 (95% confidence interval [CI] = 0.61-0.82). By linear regression using individual-level data, we observed a 0.76% (95% CI = 0.71-0.81) increase in SRF% for every 1% increase in SRV%. Split renal volume had a specificity of 88% for discriminating SRF at a threshold that could influence the decision of which kidney is to be removed (between-kidney difference ≥10%). Predonation SRV and SRF both moderately predicted kidney function 6 to 12 months after donation: r = 0.75 for SRV and r = 0.73 for SRF; Δ r = 0.05 (–0.02, 0.13). Limitations: Most studies were retrospective and measured SRV and SRF only on selected living donor candidates. Efficiency gains in removing the SRF from the evaluation will depend on the transplant program. Conclusion: Split renal volume has the potential to replace SRF for some candidates. However, it is uncertain whether it can do so reliably and routinely across different transplant centers. The impact on clinical decision-making needs to be assessed in well-designed prospective studies. Trial registration: The digitized data are registered with Mendeley Data (doi10.17632/dyn2bfgxxj.2).

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Association of mGFR of the Remaining Kidney Divided by Its Volume before Donation with Functional Gain in mGFR among Living Kidney Donors

Cited by 19 publications

References 31 publications

What is the significance of end-stage renal disease risk estimation in living kidney donors?

What is the significance of end-stage renal disease risk estimation in living kidney donors?

GFR ≤25 years postdonation in living kidney donors with (vs. without) a first-degree relative with ESRD

Can Split Renal Volume Assessment by Computed Tomography Replace Nuclear Split Renal Function in Living Kidney Donor Evaluations? A Systematic Review and Meta-Analysis

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