Change in renal function following laparoscopic donor nephrectomy using 99 mTc-diethylenetriaminepentaacetic acid scan.

PURPOSE

We assessed the change in remaining kidney function after laparoscopic donor nephrectomy using serial technetium 99m diethylenetriaminepentaacetic acid (DTPA) scans and investigated the factors affecting the course.

METHODS

Data from 155 donors were obtained from a prospectively maintained database. All donors underwent consecutive DTPA scans preoperatively and 1 month, 6 months and 1 year postoperatively. We investigated the longitudinal change in renal function after surgery and analyzed parameters to influence the perioperative glomerular filtration rate (GFR) change.

RESULTS

The changes in GFR according to the DTPA scan presented significant improvement from 1 month up to 2 years after donation (all p < 0.001). The DTPA-GFR of the remaining kidney increased by 14.8% to 58.2 ± 10.6 ml/min/1.73 m(2) (p < 0.001) and by 33.9% to 78.0 ± 14.0 ml/min/1.73 m(2) at 1 month and 1 year after surgery, respectively (p < 0.001). Only 21.9% of donors categorized into chronic kidney disease (CKD) stage 3 or more at 1 year after donation were <60 ml/min/1.73 m(2) according to DTPA-GFR. Multivariate regression analysis revealed that the increase in DTPA-GFR at 1 year was negatively associated with patient age (p = 0.005), BMI (p = 0.04) and preoperative DTPA-GFR of remaining kidney (p = 0.009).

CONCLUSIONS

The DTPA-GFR of remaining kidney increased steadily for up to 2 years after surgery. Younger donors with lower body mass index and those with lower initial function of the remaining kidney demonstrated a greater increase in DTPA-GFR after nephrectomy. Many of the donors with CKD stage 3 after donation have good renal function according to the results of DTPA-GFR.