Abstract: TH-OR134
Living Kidney Donor Visceral Adipose Tissue Predicts Donor Histopathology and Post-Donation Kidney Functional Decline
Session Information
- Policy and Pretransplant Considerations
November 07, 2019 | Location: 151, Walter E. Washington Convention Center
Abstract Time: 05:42 PM - 05:54 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Augustine, Joshua J., Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Stern, Karen L., Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Armanyous, Sherif, Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Kamel, Ahmed Mohamed sayed, Faculty of Pharmcay, Cairo University, Giza, Egypt
- Poggio, Emilio D., Cleveland Clinic, Cleveland, Ohio, United States
Background
Living kidney donors have become increasingly complex with increased obesity and older age. Given the association of visceral adipose tissue (VAT) and kidney functional decline in the general population, we hypothesized that VAT in living donors may predict baseline histopathology and post-donation kidney function.
Methods
We measured VAT in 170 living kidney donors using pre-donation computerized tomography (CT) imaging and computerized software at a single lumbar level: L3-L4 for females and L2-L3 for males. All donor kidneys had preimplantation biopsies. Chronic histologic findings were defined as 2 of 3 biopsy findings: >5% global glomerulosclerosis, any interstitial fibrosis with tubular atrophy, or the presence of any arteriosclerosis. Kidney function was recorded by estimated glomerular filtration rate (eGFR) pre-donation and at 1, 12, and 24 months post-donation. GFR decline was defined as the percent drop in eGFR at 12 months vs. pre-donation.
Results
Greater VAT by tertiles correlated with older donor age, male gender, smoking, higher blood pressure, lipid abnormalities, and body mass index (BMI), (TABLE). Donor glomerulosclerosis and interstitial fibrosis on biopsy also correlated with VAT (TABLE). The highest tertile of VAT also correlated with lower pre-donation eGFR and less GFR recovery (FIGURE). After controlling for all associated donor variables including age, gender, and BMI, donor VAT remained an independent predictor of chronic histologic findings (OR: 1.02, 95% CI 1.01-1.04, p<0.001), and GFR decline after donation (b = 0.04, 95% CI: 0.02 to 0.07, p=0.001).
Conclusion
Living kidney donor VAT using standardized CT measurements correlated independently with both histopathologic findings and kidney functional decline after donation. VAT measurement may allow for donor risk stratification and may identify donors at higher risk for long term kidney functional impairment.
Funding
- Private Foundation Support