Long-term follow-up of renal function in recipients and donors following pediatric kidney transplantation

Abstract

Of 125 children undergoing kidney transplantation (tx), 87 received their grafts from living donors. Renal function of recipients (R) and donors (D) was assessed by glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) determined by clearances of inulin and para-aminohippuric acid. Rs were investigated yearly and Ds on alternate years. Within 5 months of tx, absolute GFR and ERPF (ml/min) were significantly lower in R than in D, and the differences in absolute GFR and ERPF between D and R were directly related to the difference in body surface area (BSA) between the two subjects. R and D pairs were repeatedly followed for 4, 6, and 8 years and the absolute GFR of R did not change during follow-up, while relative GFR decreased. Relative GFR decreased most in R, with the greatest difference in BSA between D and R at tx. In the donors, however, both absolute and relative GFR increased significantly up to 8 years. In conclusion, renal function of the two kidneys from the donor, i.e., the grafted kidney in the R and the single native kidney of the D, differed. The native kidney showed a capacity to increase its absolute and relative function with time. The grafted kidney, however, did not show an increase in absolute GFR, resulting in decrease in relative GFR, and the greater difference in BSA between D and R at tx, the greater fall in relative GFR of the R.

Renal blood flow using arterial spin labelling MRI and calculated filtration fraction in healthy adult kidney donors Pre-nephrectomy and post-nephrectomy

“…Previous studies have shown that the increases in GFR and eRPF in the remaining kidney following donation are maintained over many years [24]. Bugge et al studied eight donors over the immediate 24 h post-nephrectomy [25]; GFR and eRPF increased by 70 % within 1 h and was maintained over 24 h. Pabico et al reported mean post-nephrectomy GFR increase of 37 % and mean eRPF of 55 %; the FF was not significantly different pre-and post-nephrectomy [26], similar to the results reported by Tent et al [27].…”

Potential cardiovascular risk factors in paediatric renal transplant recipients

“…For this reason, larger prospective studies should be done in paediatric renal transplant recipients to evaluate ambulatory BP, lipid profile and left ventricular mass [37]. Third, in investigations performed in renal transplant recipients it would be of utmost importance that the interpretation of renal function relies on an accurate method to measure glomerular filtration rate, such as the inulin clearance test [38]. However the Schwartz formula, when followed serially, should still allow group comparisons [26].…”

Bladder dysfunction in children and adolescents after renal transplantation

“…The glomerular filtration rate (GFR) was measured by renal clearance of inulin, using the standard clearance technique during water diuresis and continuous infusion [21,22], or plasma clearance of iohexol, using the slope curve.…”