Post-Donation Kidney Function is Highly Predictable for Donors and to a Lesser Degree for Recipients

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IntroductionSafety is of highest priority for a living kidney donor. Kidney function after donation should be sufficient and reflect the adaptive capacity of the remaining kidney. We have measured the pre- and post-donation kidney function in the living donor and corresponding recipient and compared it with the predicted function based on adaptive increase, age, gender and weight.MethodsBetween Jan 2014 and Oct 2016 all consecutive living donor and recipient pairs, who agreed to share their data, were included in this study. In total, kidney function was analyzed in 47 donors and recipients. In the donor baseline pre-donation serum creatinine (S-Crea) was compared to the lowest S-Crea during the first 3 months post-donation: Expected donor S-Crea postdonation = pre-donation S-Crea * 1.49. In the recipient the lowest observed S-Crea during the first three post-transplant months was compared to the expected S-Crea based on a previously established formula including an adaptive increase of 35% and integrating donor and recipient age, weight and gender using a modification of the Cockroft-Gault formula: Expected recipient S-Crea post-transplant = ((140-recipient age)*recipient weight*recipient gender)/(((0.6*(140-donor age)*donor weight*donor gender)/predonation donor S-Crea)+8.7).ResultsOverall the expected post-donation S-Crea in the donor was highly predictable, the mean difference between observed and expected S-Crea was 1.3 umol/l, 89% of the observed values were measured within +/− 15% of the predicted values. Only 4 donors showed S-Creas outside the predicted range, all of the values lower than expected. In contrast the recipient S-Creas were less predictable. The mean difference between observed and predicted S-Crea was 11.5 umol/l, only 38% of all values were in the +/− 15% range. A lower adaptive increase in the remaining kidney in the living donor was associated with a lower adaptive increase in the mate kidney transplanted to the recipient. No age-dependent difference in adaptive increase could be detected.ConclusionPost-donation function in living donors can be predicted with a high accuracy, whereas post-transplant function in the recipient probably needs more time to reach the baseline.NCCR Kidney funded by the Swiss National Science Foundation.

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