Insulin Sensitivity After Living Donor Nephrectomy

Bekir Tanriover, Ildiko Lingvay, Firas Ahmed, Burhaneddin Sandikci, Sumit Mohan, Serge Cremers, Wahida Karmally, Prince Mohan, Jeffrey Newhouse, Sneha Ragunathan, Nashila AbdulRahim, Venkatesh Kumar Ariyamuthu, Lloyd E. Ratner, David J. Cohen

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The kidney is essential for glucose and insulin metabolism. Living kidney donors (LKDs) experience a reduction in glomerular filtration rate of 25 to 30 mL/min after donor nephrectomy. Little is known about the effect of glomerular filtration rate decline on insulin sensitivity in LKDs. Methods: We conducted a prospective pilot study on 9 LKDs (N = 9) who underwent dynamic metabolic testing (mixed meal tolerance test) to measure proxies of insulin sensitivity (homeostatic model assessment of insulin resistance, the area under curve [AUC] for insulin/glucose ratio, and Matsuda insulin sensitivity index) before and 3 months after donor nephrectomy. The primary outcome was the change in insulin sensitivity indices (delta [post-nephrectomy – pre-nephrectomy]). Results: Four of the donors had a body mass index (BMI) between 32.0 and 36.7 predonation. Post–donor nephrectomy, compared with prenephrectomy values, median insulin AUC increased from 60.7 to 101.7 hr*mU/mL (delta median 33.3, P = .04) without significant change in median glucose AUC levels from 228.9 to 209.3 hr*mg/dL (delta median 3.2, P = .77). There was an increase in the median homeostatic model assessment of insulin resistance from 2 to 2.9 (delta median 0.8, P = .03) and the AUC insulin/glucose ratio from 30.9 to 62.1 pmol/mmol (delta median 17.5, P = .001), whereas the median Matsuda insulin sensitivity index decreased from 5.9 to 2.9 (delta median −2, P = .05). The changes were more pronounced in obese (BMI >32) donors. Conclusion: LKDs appear to have a trend toward a decline in insulin sensitivity post–donor nephrectomy in the short term, especially in obese donors (BMI >32). Further investigation with a larger sample size and longer follow-up is needed.

Original languageEnglish (US)
Pages (from-to)1858-1864
Number of pages7
JournalTransplantation proceedings
Volume53
Issue number6
DOIs
StatePublished - Jul 1 2021

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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