Long-term Renal Function in Living Kidney Donors Who Had Histological Abnormalities at Donation

Abstract

Background Recent evidence suggests that living kidney donors are at an increased risk of end-stage renal disease. However, predicting which donors will have renal dysfunction remains challenging, particularly among those with no clinical evidence of disease at the time of donation. Although renal biopsies are not routinely performed as part of the donor evaluation process, they may yield valuable information that improves the ability to predict renal function in donors. Methods We used implantation protocol biopsies to evaluate the association between histological abnormalities in the donated kidney and postdonation renal function (estimated glomerular filtration rate, eGFR) of the remaining kidney in living kidney donors. Longitudinal analysis using mixed-effects linear regression was used to account for multiple eGFR measures per donor. Results Among 310 donors between 1997 and 2012, median (IQR) follow-up was 6.2 (2.5–8.7; maximum 14.0) years. In this cohort, the overall prevalence of histological abnormalities was 65.8% (19.7% abnormal glomerulosclerosis, 23.9% abnormal interstitial fibrosis and tubular atrophy (IFTA), 4.8% abnormal mesangial matrix increase, 32.0% abnormal arteriolar hyalinosis, and 32.9% abnormal vascular intimal thickening). IFTA was associated with a 5-mL/min/1.73m2 decrease of postdonation eGFR after adjusting for donor age at donation, sex, race, preoperative systolic blood pressure, preoperative eGFR, and time since donation (p<0.01). Conclusions In this single-center study, among healthy individuals cleared for living donation, IFTA was associated with decreased postdonation eGFR, while no other subclinical histological abnormalities provided additional information.

Kidney structural characteristics based on a kidney biopsy and contrast‐enhanced computed tomography in healthy living kidney donors

“…Studies investigating predictors of renal outcome after donation have different conclusions. Some agrees with Issa et al and found a large glomerular volume to be a predictor of worse renal outcome (Elsherbiny et al, 2014) or interstitial fibrosis/tubular atrophy (Fahmy et al, 2016). Elsherbiny et al (2014) also found an association between glomerular sclerosis and a decreased post-donation GFR.…”

Larger nephron size, low nephron number, and nephrosclerosis on biopsy as predictors of kidney function after donating a kidney

“…4Structural predictors had generally modest associations with GFR that were somewhat inconsistent between eGFR and mGFR in our study. Some prior studies have found nephrosclerosis to predict a lower eGFR recovery post-donation, (10,12,14) whereas other studies have not found this. (11,13) We found only one measure of nephrosclerosis predicted a lower mGFR and none predicted a lower eGFR after adjusting for baseline characteristics.…”

Larger Nephron Size and Nephrosclerosis Predict Progressive CKD and Mortality after Radical Nephrectomy for Tumor and Independent of Kidney Function

“…1 Another study looked at long-term outcomes of 310 donors and found that glomerulosclerosis and increased interstitial fibrosis predict a more pronounced eGFR decline after donation. 26 Recipients of kidneys from living donors who have higher percentage IF/TA and larger cross-sectional tubular area are at a higher risk for graft failure. 27 Studies in patients with specific kidney diseases have also found measures of nephrosclerosis and nephron size to be predictive of progressive CKD.…”