Abstract: SA-OR078

Early Post-Donation eGFR and ESRD in Living Kidney Donors

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Massie, Allan, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
  • Fahmy, Lara, Johns Hopkins University School of Medicine, Detroit, Michigan, United States
  • Henderson, Macey L., Johns Hopkins, Baltimore, Maryland, United States
  • Snyder, Jon J., Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States
  • Holscher, Courtenay M, Johns Hopkins University, Baltimore, Maryland, United States
  • Dibrito, Sandra R, Johns Hopkins, Baltimore, Maryland, United States
  • Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
Background

Several studies have shown higher ESRD risk in living kidney donors (LKDs) compared to healthy nondonors. All LKDs may not equally tolerate nephrectomy. Identifying post-donation risk factors for ESRD would improve post-donation counseling and care. We studied the association between early post-donation eGFR and subsequent ESRD risk.

Methods

Using SRTR data, we studied 64,989 LKDs 1999-2015 who were ESRD-free 9 months post-donation and who had at least one valid post-donation SCr value reported to OPTN between 3-30 months post-donation. When eGFR measured between 3-9 months post-donation (6-month eGFR) was missing, we multiply imputed based on pre-donation eGFR and other post-donation eGFR values. We studied the association between 6-month eGFR and post-donation ESRD (via CMS linkage) using Cox regression, adjusting for age, sex, race (black vs nonblack), pre-donation eGFR, BMI, and 1st-degree biological relationship to recipient.

Results

Median (IQR) 6-month eGFR was 63.2 (54.2-74.3) mL/min/1.73 m2. Out of 64,989 donors, 50 progressed to ESRD during the study period. Donors with lower 6-month eGFR had greater incidence of ESRD (Figure). There was no evidence of association between pre-donation eGFR and post-donation ESRD risk (p=0.3, Table). A 10-unit difference in 6-month eGFR was associated with 32% decreased risk of ESRD (aHR=0.53 0.68 0.87, p<0.01, Table).

Conclusion

Lower eGFR in the first 6 months post-donation is associated with higher subsequent risk of post-donation ESRD in living kidney donors. Careful monitoring of early post-donation eGFR is essential to provide adequate post-donation care and counseling.

 Model 1Model 2Model 3
pre-donation eGFR0.77 0.91 1.08-0.87 1.06 1.29
6m post-donation eGFR-0.53 0.68 0.870.49 0.65 0.87

aHRs per 10 units eGFR. Bold p<0.05

Funding

  • NIDDK Support