Santos L, Macário F, Alves R, Mota A, Campos M
Department of Nephrology, Rainha Santa Isabel Hospital, Torres Novas, Portugal.
Transplant Proc. 2010 Jun;42(5):1484-6. doi: 10.1016/j.transproceed.2009.12.078.
There is good evidence that long-term graft survival is superior when living donors are used for kidney transplantation. Nevertheless, an assessment of potential risks associated with living donation is of particular interest.
In this single-center study, we evaluated the renal function of 31 kidney living donors (1997-2003) at 2-13.2 years after nephrectomy. The purpose of this study was to evaluate perioperative complications, renal function, new-onset proteinuria, and hypertension.
Living related donation was performed in all cases. The average time after donation was 5.7 +/- 2.4 years. The mean age at nephrectomy was 46.3 +/- 9.0 years (range, 25-64), and 26 (83.9%) donors were females. Twelve patients (29%) were older than 50 years. The left kidney was used in 25 patients (80.6%). Surgical complications occurred in 2 patients. Glomerular filtration rate (GFR) decreased from 116.9 +/- 23 to 77.7 +/- 19.2 mL/min/1.73 m(2) (P < .001). Five patients (16.1%) developed a postdonation GFR between 50 and 60 mL/min/1.73 m(2). Patients with lower GFR values after uninephrectomy showed lower predonation values (P < .05). Older patients (>50 years) displayed lower postdonation GFR than younger ones. We did not observe an increased prevalence of low postdonation GFR over time nor significant differences in protein excretion and blood pressure.
Living donor nephrectomy appears to be an acceptably safe intervention. Despite a reduction in GFR, the postdonation incidence of hypertension was low and proteinuria was not observed in any donor, even among previously hypertensive patients. Rigorous donor follow-up is recommended to identify persons at risk.
有充分证据表明，肾移植采用活体供体时长期移植物存活率更高。然而，对活体供肾潜在风险的评估尤为重要。
在这项单中心研究中，我们评估了31例肾活体供者（1997 - 2003年）在肾切除术后2至13.2年的肾功能。本研究的目的是评估围手术期并发症、肾功能、新发蛋白尿和高血压情况。
所有病例均为亲属活体供肾。捐献后的平均时间为5.7±2.4年。肾切除时的平均年龄为46.3±9.0岁（范围25 - 64岁），26例（83.9%）供者为女性。12例患者（29%）年龄超过50岁。25例患者（80.6%）使用的是左肾。2例患者出现手术并发症。肾小球滤过率（GFR）从116.9±23降至77.7±19.2 mL/min/1.73 m²（P <.001）。5例患者（16.1%）捐献后的GFR在50至60 mL/min/1.73 m²之间。单侧肾切除术后GFR值较低的患者术前GFR值也较低（P <.05）。年龄较大的患者（>50岁）捐献后的GFR低于年轻患者。我们未观察到捐献后低GFR的患病率随时间增加，也未观察到蛋白尿排泄和血压有显著差异。
活体供肾肾切除术似乎是一种可接受的安全干预措施。尽管GFR有所下降，但捐献后高血压的发生率较低，且未在任何供者中观察到蛋白尿，即使是既往有高血压的患者。建议对供者进行严格随访以识别有风险的个体。
