High BMI and male sex as risk factor for increased short-term renal impairment in living kidney donors – Retrospective analysis of 289 consecutive cases

Unger, Lukas; Feka, Joy; Sabler, Philipp; Rasoul‐Rockenschaub, Susanne; Györi, Georg; Hofmann, Michael; Schwarz, Christoph; Soliman, Thomas; Böhmig, Georg A.; Kainz, Alexander; Salat, Andreas; Berlakovich, Gabriela

doi:10.1016/j.ijsu.2017.09.007

Cited by 13 publications

(13 citation statements)

References 25 publications

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“…In addition, we found no significant differences between HARP and LDN in terms of operative outcome, postoperative outcome and postoperative kidney function except for blood loss. [5,6,12]. Our institute is one of the largest centers in living kidney donation and transplantation in Western Europe, therefore the beneficial effect of hospital volumes might result in better outcome.…”

Section: Discussionmentioning

confidence: 99%

Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy

et al. 2019

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Background The aim of this study was to examine the difference in outcome between hand-assisted retroperitoneoscopic and laparoscopic living donor nephrectomy in obese donors, and the impact of donor body mass index on outcome. Methods Out of 1108 living donors who underwent hand-assisted retroperitoneoscopic or laparoscopic donor nephrectomy between 2010 and 2018, 205 were identified having body mass index ≥ 30. These donors were included in this retrospective study, analyzing postoperative outcomes and remnant renal function. Results Out of 205 donors, 137 (66.8%) underwent hand-assisted retroperitoneoscopic donor nephrectomy and 68 donors (33.2%) underwent laparoscopic donor nephrectomy. Postoperative outcome did not show any significant differences between the hand-assisted retroperitoneoscopic donor nephrectomy group and the laparoscopic donor nephrectomy group in terms of major complications (2.2% vs. 1.5%, P = 0.72), postoperative pain scale (4 vs. 4, P = 0.67), and the length of stay (3 days vs. 3 days, P = 0.075). The results of kidney function in donors after nephrectomy demonstrated no significant differences between the groups. Additional analysis of 29 donors with body mass index ≥ 35 (14.1%) as compared with 176 donors with body mass index 30-35 (85.9%) revealed no significant differences between groups in postoperative outcomes as well as kidney function after donation. Conclusion Our results show that laparoscopic living donor nephrectomy for obese donors is safe and feasible with good postoperative outcomes. There were no significant differences regarding postoperative outcome between hand-assisted retroperitoneoscopic and laparoscopic donor nephrectomy. Furthermore, the outcome in donors with body mass index ≥ 35 was comparable to donors with body mass index 30-35.

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Section: Discussionmentioning

confidence: 99%

Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy

et al. 2019

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“…Part of that workup includes an analysis of the patient's BMI. There have been conflicting studies regarding the association between donor BMI and postoperative renal compromise [1][2][3][4][5][6][7][8]. Motivated by these conflicting studies, we examine the association of kidney MAP score with postoperative renal function in healthy donors.…”

Section: Discussionmentioning

confidence: 99%

“…However, our study also incorporates these concepts in the examination of long term renal function in a cohort of patients undergoing HALDN. Additionally, age and male sex have previously been correlated with decreased postoperative donor renal function [3,23]. By definition, the MDRD 2006 equation correlates age, sex, and race with eGFR because these variables are included in the calculation of eGFR.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have evaluated the impact of various preoperative patient-specific and imaging-derived characteristics on postoperative renal function following donor nephrectomy. Examinations of large cohorts of patients suggest that age, male sex, and body mass index (BMI) are predictive of decreased postoperative renal function in patients undergoing donor nephrectomy [1][2][3][4]. However, other studies have shown that BMI has no effect on long term glomerular filtration rate (eGFR) in the donor nephrectomy population [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Mayo Adhesive Probability (MAP) score of non-donated kidney aids in predicting post-operative renal function following donor nephrectomy

et al. 2020

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Background: To examine the association of preoperative Mayo Adhesive Probability (MAP) scores in the donor (MAP d) and non-donor kidneys (MAP nd) with post-donation renal function. Methods: Three hundred thirty-one patients undergoing hand assisted laparoscopic donor nephrectomy (HALDN) were reviewed. MAP d and MAP nd were obtained. Estimated glomerular filtration rate (eGFR) was recorded preoperatively and at 1 day, 1 month, and 6 months postoperatively. Results: Two hundred females and 131 males were evaluated with median BMI 26.4 kg/m 2 (range 17.1-39.6) and median age 45 years (range 19-78). MAP d score was 0 for 231 patients (69.8%) and > 0 for 100 patients (30.2%). MAP nd score was 0 for 234 patients (70.7%) and > 0 for 97 patients (29.3%). The median preoperative eGFR was 86.6 ml/min/ 1.73m 2 (range 48.8-138.4). After adjusting for preoperative eGFR, BMI, ASA score, and kidney sidedness, postoperative eGFR was associated with MAP score in the non-donated kidney (p = 0.014) but not in the donated kidney (p = 0.24). Compared to donors with MAP nd = 0, donors with a MAP nd > 0, mean eGFR was − 2.33 ml/min/1.73m 2 lower at postoperative day 1 (95% CI − 4.24 to − 0.41, p = 0.018), − 3.02 ml/min/1.73m 2 lower at 1 month (95% CI − 5.11 to − 0.93, p = 0.005), and − 2.63 ml/min/1.73m 2 lower at 6 months postoperatively (95% CI − 5.01 to − 0.26, p = 0.030). Conclusions: MAP score > 0 in the non-donated kidney is associated with worse renal function in the 6 months following HALDN.

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“…Unger et al reported short-term outcomes following donor nephrectomy in obese versus non-obese donors [49]. In a retrospective analysis of 289 Austrian kidney donors who underwent nephrectomy between 2006 and 2015, 126 donors had a BMI ≤ 25 kg/m 2 , 120 had a BMI between 25 and 30 kg/ m 2 and 43 had a BMI ≥ 30 kg/m 2 .…”

Section: Obese Donorsmentioning

confidence: 99%

One size does not fit all: understanding individual living kidney donor risk

Asgari

Hilton

2020

Pediatr Nephrol

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Living donor kidney transplantation is the optimal treatment for end-stage kidney disease (ESKD) but confers a risk upon the donor, both in the short term and many years after donation. While perioperative mortality is low and longevity does not appear to be adversely affected, there are small increases in the risk of other important morbidities. The overall risk of ESKD among donors is low but appears to be three-to five-fold higher than among healthy non-donors, and this relative risk is even higher among donors of African ancestry. For these individuals, apolipoprotein L1 genotyping may be helpful. Kidney donors also have an increased risk of developing hypertension post-donation and a modestly increased risk of developing gout. Living kidney donation also increases the risk of gestational hypertension and preeclampsia while not affecting other important pregnancy outcomes. As our understanding of donor risk grows, it is important to counsel prospective donors according to their individual risk and so obtain better informed donor consent. As knowledge advances, it is also important that all clinicians who manage kidney transplant candidates have an up to date understanding of donor risk to inform shared decision making.

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High BMI and male sex as risk factor for increased short-term renal impairment in living kidney donors – Retrospective analysis of 289 consecutive cases

Cited by 13 publications

References 25 publications

Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy

Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy

Mayo Adhesive Probability (MAP) score of non-donated kidney aids in predicting post-operative renal function following donor nephrectomy

One size does not fit all: understanding individual living kidney donor risk

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