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 Wang, Jacqueline M.
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 L.
AU - Segev, Dorry L.
N1 - Funding Information:
This work was supported by grants number F32DK109662 (PI: Holscher), F32DK105600 (PI: DiBrito), F32DK113719 (PI: Jackson), K01DK101677 (PI: Massie), K01DK114388 (PI: Henderson), K24DK101828 (PI: Segev), and R01DK096008 (PI: Segev) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); F32AG053025 (PI: Haugen) from the National Institute on Aging (NIA); and an American College of Surgeons Resident Research Scholarship (PI: Holscher). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services; nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or an interpretation by the SRTR or the U.S. Government.
Funding Information:
This work was supported by grants number F32DK109662 (PI: Holscher), F32DK105600 (PI: DiBrito), F32DK113719 (PI: Jackson), K01DK101677 (PI: Massie), K01DK114388 (PI: Henderson), K24DK101828 (PI: Segev), and R01DK096008 (PI: Segev) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); F32AG053025 (PI: Haugen) from the National Institute on Aging (NIA); and an American College of Surgeons Resident Research Scholarship (PI: Holscher). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services; nor does mention of trade names, commercial products, or organizations imply en‐ dorsement by the U.S. Government. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or an interpretation by the SRTR or the U.S. Government.
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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UR - http://www.scopus.com/inward/citedby.url?scp=85052848188&partnerID=8YFLogxK
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 -