Chien C-H, Wang H-H, Chiang Y-J, Chu S-H, Liu H-E, Liu K-L
Graduate Institute of Clinical Medical Sciences, Department of Surgery, School of Nursing, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Transplant Proc. 2010 Apr;42(3):692-5. doi: 10.1016/j.transproceed.2010.02.069.
Laparoscopic donor nephrectomy (LDN) has become the method of choice for living-donor kidney transplantation. However, LDN may result in decreased renal function in the donor, and risk of end-stage renal failure has been reported.
To evaluate changes in renal function after LDN.
The study included 51 living donors of renal transplants between March 2002 and December 2008. Before kidney donation, we computed the initial function of the kidney preserved in the donor using 24-hour creatinine clearance (Ccr) and functional ratio as revealed at technetium 99m dimercaptosuccinic acid renal scanning. After kidney donation, serum creatinine concentration (sCr) and Ccr were calculated on postoperative day 2 and every 3 months thereafter.
After LDN, mean sCr increased immediately, from 0.90 to 1.31, as did Ccr of the kidney preserved in the donor, from 58.2 to 79.6, a 36.9% increase. A greater percent increase in function was observed in younger donors and those with lower initial Ccr of the preserved kidney. Although 9.8% of donors demonstrated slightly decreased renal function of the preserved kidney at last follow-up, renal function was adequately preserved in most donors.
Younger donors and those with lower initial function of the preserved kidney before nephrectomy demonstrate a greater increase in function after nephrectomy. Age might be a risk factor for decreased renal function after LDN. Older potential living donors may need more careful evaluation before kidney donation.
腹腔镜供肾切除术（LDN）已成为活体供肾肾移植的首选方法。然而，LDN可能导致供体肾功能下降，且有报告称存在终末期肾衰竭风险。
评估LDN术后肾功能的变化。
该研究纳入了2002年3月至2008年12月期间的51例活体肾移植供体。在肾脏捐献前，我们使用24小时肌酐清除率（Ccr）以及锝99m二巯基丁二酸肾扫描显示的功能比来计算供体留存肾脏的初始功能。肾脏捐献后，在术后第2天以及此后每3个月计算血清肌酐浓度（sCr）和Ccr。
LDN术后，平均sCr立即从0.90升至1.31，供体留存肾脏的Ccr也从58.2升至79.6，增加了36.9%。在年轻供体以及留存肾脏初始Ccr较低的供体中，观察到功能增加的百分比更大。尽管在最后一次随访时有9.8%的供体显示留存肾脏的肾功能略有下降，但大多数供体的肾功能得到了充分保留。
年轻供体以及肾切除术前留存肾脏初始功能较低的供体在肾切除术后功能增加更大。年龄可能是LDN术后肾功能下降的一个风险因素。年龄较大的潜在活体供体在肾脏捐献前可能需要更仔细的评估。
