Kidney Week

Abstract: SA-OR080

Predonation Recruitment of Renal Functional Reserve Capacity Is Associated with Early Renal Adaptation after Living Kidney Donation

Session Information

• Transplant Economics and Live Donor Outcomes
  November 04, 2017 | Location: Room 390, Morial Convention Center
  Abstract Time: 06:18 PM - 06:30 PM

Category: Transplantation

• 1702 Transplantation: Clinical and Translational

Authors

• van Londen, Marco, University Medical Center Groningen, Groningen, Netherlands

Marco van Londen, MD



http://www.rug.nl/staff/m.van.londen/

• Weijden, Jessica Van der, University Medical Center Groningen, Groningen, Netherlands

Jessica Van der Weijden,

• Sanders, Jan-Stephan, University Medical Center Groningen, Groningen, Netherlands

Jan-Stephan Sanders,

• Berger, Stefan P., University Medical Center Groningen, Groningen, Netherlands

Stefan P. Berger,

• Bakker, Stephan J.L., University Medical Center Groningen, Groningen, Netherlands

Stephan J.L. Bakker,

• De Borst, Martin H., University Medical Center Groningen, Groningen, Netherlands

Martin H. De Borst,

• Navis, Gerjan, University Medical Center Groningen, Groningen, Netherlands

Gerjan Navis,

Background

Early renal adaptation after kidney donation results in a GFR above 50% of the predonation value. This is probably due to early hemodynamic changes, whereas long-term renal adaptation, which may further increase GFR in the months thereafter is likely more structural in nature. Recruitment of Renal Reserve Capacity assessed by the renal response to dopamine infusion (RRC) is considered to reflect functional reserve capacity, but it is unknown whether it predicts short- or long-term renal adaptation or both. In this study we investigate the association between pre-donation RRC and GFR changes after donation.

Methods

In 750 living kidney donors between 1984 and 2017, we prospectively measured mGFR (¹²⁵-Iothalamate clearance) and RRC. We performed multivariable linear regression analysis with short-term postdonation mGFR as dependent variable. In a subgroup with 5 year follow-up after donation we assessed the association with long-term mGFR.

Results

Mean donor age was 52±11 years, 48% were male. Mean predonation mGFR was 107±28 ml/min, mGFR_Dopamine was 115±30 ml/min, resulting in a RRC of 9±10 ml/min. Three months postdonation, mGFR was 73±15 ml/min and mGFR_Dopamine was 76±15 ml/min, indicating that donors still had RRC (2.7±5.8 ml/min, p<0.001). Predonation RRC was associated with mGFR preservation, independent of age, mGFR, blood pressure and BMI (st. β 0.12, p<0.001, final model R²=0.63). In the subgroup of donors of whom 5-year follow-up data was available, RRC was neither associated with absolute mGFR at 5 years postdonation (st. β 0.02, p=0.78), nor with compensatory mGFR increase between 3 months and 5 year after donation (st. β 0.03, p=0.67).

Conclusion

Dopamine-recruited renal reserve capacity is independently associated with preservation of mGFR early after donation, but not with long-term mGFR. This indicates that RC_Dopamine is a marker of early, hemodynamic-driven, adaptation to kidney donation rather than long-term mGFR changes. More long-term follow-up data are needed to provide conclusive results about the use of dopamine in living kidney donors.

Funding

• Government Support - Non-U.S.