TY - JOUR
T1 - Live donor renal anatomic asymmetry and posttransplant renal function
AU - Tanriover, Bekir
AU - Fernandez, Sonalis
AU - Campenot, Eric S.
AU - Newhouse, Jeffrey H.
AU - Oyfe, Irina
AU - Mohan, Prince
AU - Sandikci, Burhaneddin
AU - Radhakrishnan, Jai
AU - Wexler, Jennifer J.
AU - Carroll, Maureen A.
AU - Sharif, Sairah
AU - Cohen, David J.
AU - Ratner, Lloyd E.
AU - Hardy, Mark A.
N1 - Publisher Copyright:
Copyright © 2015 Wolters Kluwer Health, Inc.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background. Relationship between live donor renal anatomic asymmetry and posttransplant recipient function has not been studied extensively. Methods. We analyzed 96 live kidney donors, who had anatomical asymmetry (>10% renal length and/or volume difference calculated from computerized tomography angiograms) and their matching recipients. Split function differences (SFD) were quantified with technetium-dimercaptosuccinic acid renography. Implantation biopsies at time 0 were semiquantitatively scored. A comprehensive model using donor renal volume adjusted to recipient weight (Vol/Wgt), SFD, and biopsy score was used to predict recipient estimated glomerular filtration rate (eGFR) at 1 year. Primary analysis consisted of a logistic regression model of outcome (odds of developing eGFR>60 mL/min/1.73m2 at 1 year), a linear regression model of outcome (predicting recipient eGFR at one-year, using the chronic kidney disease-epidemiology collaboration formula), and a Monte Carlo simulation based on the linear regression model (N=10, 000 iterations). Results. In the study cohort, the mean Vol/Wgt and eGFR at 1 year were 2.04 mL/kg and 60.4 mL/min/1.73 m2, respectively. Volume and split ratios between 2 donor kidneys were strongly correlated (r = 0.79, P < 0.001). The biopsy scores among SFD categories (<5%, 5%-10%, >10%) were not different (P = 0.190). On multivariate models, only Vol/Wgt was significantly associated with higher odds of having eGFR > 60 mL/min/1.73 m2 (odds ratio, 8.94, 95% CI 2.47-32.25, P = 0.001) and had a strong discriminatory power in predicting the risk of eGFR less than 60 mL/min/1.73 m2 at 1 year [receiver operating curve (ROC curve), 0.78, 95% CI, 0.68-0.89]. Conclusions. In the presence of donor renal anatomic asymmetry, Vol/Wgt appears to be a major determinant of recipient renal function at 1 year after transplantation. Renography can be replaced with CT volume calculation in estimating split renal function.
AB - Background. Relationship between live donor renal anatomic asymmetry and posttransplant recipient function has not been studied extensively. Methods. We analyzed 96 live kidney donors, who had anatomical asymmetry (>10% renal length and/or volume difference calculated from computerized tomography angiograms) and their matching recipients. Split function differences (SFD) were quantified with technetium-dimercaptosuccinic acid renography. Implantation biopsies at time 0 were semiquantitatively scored. A comprehensive model using donor renal volume adjusted to recipient weight (Vol/Wgt), SFD, and biopsy score was used to predict recipient estimated glomerular filtration rate (eGFR) at 1 year. Primary analysis consisted of a logistic regression model of outcome (odds of developing eGFR>60 mL/min/1.73m2 at 1 year), a linear regression model of outcome (predicting recipient eGFR at one-year, using the chronic kidney disease-epidemiology collaboration formula), and a Monte Carlo simulation based on the linear regression model (N=10, 000 iterations). Results. In the study cohort, the mean Vol/Wgt and eGFR at 1 year were 2.04 mL/kg and 60.4 mL/min/1.73 m2, respectively. Volume and split ratios between 2 donor kidneys were strongly correlated (r = 0.79, P < 0.001). The biopsy scores among SFD categories (<5%, 5%-10%, >10%) were not different (P = 0.190). On multivariate models, only Vol/Wgt was significantly associated with higher odds of having eGFR > 60 mL/min/1.73 m2 (odds ratio, 8.94, 95% CI 2.47-32.25, P = 0.001) and had a strong discriminatory power in predicting the risk of eGFR less than 60 mL/min/1.73 m2 at 1 year [receiver operating curve (ROC curve), 0.78, 95% CI, 0.68-0.89]. Conclusions. In the presence of donor renal anatomic asymmetry, Vol/Wgt appears to be a major determinant of recipient renal function at 1 year after transplantation. Renography can be replaced with CT volume calculation in estimating split renal function.
UR - http://www.scopus.com/inward/record.url?scp=84942456103&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84942456103&partnerID=8YFLogxK
U2 - 10.1097/TP.0000000000000599
DO - 10.1097/TP.0000000000000599
M3 - Article
C2 - 25719258
AN - SCOPUS:84942456103
SN - 0041-1337
VL - 99
SP - e66-e74
JO - Transplantation
JF - Transplantation
IS - 8
ER -