Kidney Week

Abstract: FR-PO0951

Predicting Kidney Recovery After Living Kidney Donation: Insights from Integrated Scintigraphic, Biochemical, and Ultrasonographic Assessments

Session Information

• Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Hirano, Hajime, Tokyo Joshi Ika Daigaku, Shinjuku, Tokyo, Japan

Hajime Hirano, MD, PhD

• Inoue, Takahiro, Tokyo Joshi Ika Daigaku, Shinjuku, Tokyo, Japan

Takahiro Inoue, MD

• Hanafusa, Norio, Tokyo Joshi Ika Daigaku, Shinjuku, Tokyo, Japan

Norio Hanafusa, MD, PhD

• Azuma, Haruhito, Osaka Ika Yakka Daigaku, Takatsuki, Osaka Prefecture, Japan

Haruhito Azuma, MD, PhD

Background

Accurate prediction of post-donation renal function is vital for the safety and quality of life of living kidney donors. While split renal function (SRF) by Tc-99m MAG3 scintigraphy is widely used, the combined clinical value of scintigraphic, biochemical, and ultrasonographic data remains unclear. This study provides a comprehensive, longitudinal evaluation of these multimodal assessments to identify predictors of long-term renal outcomes.

Methods

We retrospectively analyzed 34 living kidney donors (25 female, 9 male; mean age 60.5±8.2 years) who underwent nephrectomy at a single center (2021–2024). SRF and MAG3 clearance, serum creatinine, and eGFR (Japanese MDRD equation) were measured pre-donation and at 1, 6, and 12 months post-donation. Renal cortical thickness was assessed by ultrasonography. Temporal changes were analyzed using repeated-measures ANOVA, and the correlation between preoperative SRF and 12-month eGFR was examined.

Results

Preoperative SRF of the remaining kidney averaged 49.4%. Mean serum creatinine increased from 0.63 to 0.95 mg/dL at 12 months (p < 0.001). eGFR declined from 65.4 to 48.2 mL/min/1.73 m² at 1 month, partially recovered to 51.3 at 6 months, and stabilized at 53.6 at 12 months. Relative eGFR recovery was 73.7% at 1 month, 78.5% at 6 months, and 82.0% at 12 months. MAG3 clearance increased by 16.7% between 1 and 6 months and plateaued. Significant cortical thickening was observed by ultrasonography post-donation. Preoperative SRF strongly correlated with 12-month eGFR (r = 0.65, p < 0.01), supporting its predictive value.

Conclusion

Integrating MAG3 scintigraphy, biochemical indices, and ultrasonographic markers provides a practical and noninvasive approach to predicting post-donation renal outcomes. Preoperative SRF and cortical hypertrophy are robust predictors of long-term renal function, supporting personalized risk stratification. These findings have immediate clinical implications for donor selection and follow-up. Prospective, multicenter validation is warranted.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025kj73b73a