TY - JOUR
T1 - Living donor postnephrectomy kidney function and recipient graft loss
T2 - A dose-response relationship
AU - Holscher, Courtenay M.
AU - Ishaque, Tanveen
AU - Garonzik, Jacqueline
AU - Haugen, Christine E.
AU - DiBrito, Sandra R.
AU - Jackson, Kyle R.
AU - Muzaale, Abimereki D.
AU - Massie, Allan B
AU - Al Ammary, Fawaz
AU - Ottman, Shane E.
AU - Henderson, Macey
AU - Segev, Dorry
N1 - Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2018/11
Y1 - 2018/11
N2 - Development of end-stage renal disease (ESRD) in living kidney donors is associated with increased graft loss in the recipients of their kidneys. Our goal was to investigate if this relationship was reflected at an earlier stage postdonation, possibly early enough for recipient risk prediction based on donor response to nephrectomy. Using national registry data, we studied 29 464 recipients and their donors from 2008-2016 to determine the association between donor 6-month postnephrectomy estimated GFR (eGFR) and recipient death-censored graft failure (DCGF). We explored donor BMI as an effect modifier, given the association between obesity and hyperfiltration. On average, risk of DCGF increased with each 10 mL/min decrement in postdonation eGFR (adjusted hazard ratio [aHR] 1.06, 95% confidence interval [CI] 1.02-1.10, P =.007). The association was attenuated with higher donor BMI (interaction P =.049): recipients from donors with BMI = 20 (aHR 1.12, 95% CI 1.04-1.19, P =.002) and BMI = 25 (aHR 1.07, 95% CI 1.03-1.12, P =.001) had a higher risk of DCGF with each 10 mL/min decrement in postdonation eGFR, whereas recipients from donors with BMI = 30 and BMI = 35 did not have a higher risk. The relationship between postdonation eGFR, donor BMI, and recipient graft loss can inform counseling and management of living donor kidney transplant recipients.
AB - Development of end-stage renal disease (ESRD) in living kidney donors is associated with increased graft loss in the recipients of their kidneys. Our goal was to investigate if this relationship was reflected at an earlier stage postdonation, possibly early enough for recipient risk prediction based on donor response to nephrectomy. Using national registry data, we studied 29 464 recipients and their donors from 2008-2016 to determine the association between donor 6-month postnephrectomy estimated GFR (eGFR) and recipient death-censored graft failure (DCGF). We explored donor BMI as an effect modifier, given the association between obesity and hyperfiltration. On average, risk of DCGF increased with each 10 mL/min decrement in postdonation eGFR (adjusted hazard ratio [aHR] 1.06, 95% confidence interval [CI] 1.02-1.10, P =.007). The association was attenuated with higher donor BMI (interaction P =.049): recipients from donors with BMI = 20 (aHR 1.12, 95% CI 1.04-1.19, P =.002) and BMI = 25 (aHR 1.07, 95% CI 1.03-1.12, P =.001) had a higher risk of DCGF with each 10 mL/min decrement in postdonation eGFR, whereas recipients from donors with BMI = 30 and BMI = 35 did not have a higher risk. The relationship between postdonation eGFR, donor BMI, and recipient graft loss can inform counseling and management of living donor kidney transplant recipients.
KW - donors and donation: living
KW - graft survival
KW - health services and outcomes research
KW - kidney transplantation/nephrology
KW - kidney transplantation: living donor
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U2 - 10.1111/ajt.15061
DO - 10.1111/ajt.15061
M3 - Article
C2 - 30086198
AN - SCOPUS:85052848188
SN - 1600-6135
VL - 18
SP - 2804
EP - 2810
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 11
ER -