Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto, 861-8520, Japan.
Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
BMC Nephrol. 2019 Jul 26;20(1):283. doi: 10.1186/s12882-019-1464-1.
Compensation of contralateral kidney function after living-donor kidney donation is well known, and many predictive factors have been proposed. However, no prediction model has been proposed. This study was performed to establish a tool with which to estimate the degree of compensation of the contralateral kidney after living-donor kidney donation.
We retrospectively analyzed 133 living donors for renal transplantation in our institution. We defined a favorable compensation as a post-donation estimated glomerular filtration rate (eGFR) at 1 year (calculated by the Chronic Kidney Disease Epidemiology Collaboration equation) of > 60% of the pre-donation eGFR. We analyzed the living donors' clinical characteristics and outcomes.
The median (range) donor age was 59 (24-79) years, median (range) body mass index was 22.9 (16.8-32.7) kg/m, and median (range) body surface area was 1.6 (1.3-2.0) m. All donors were Japanese, and 73% of the donors were biologically related. The median (range) donor pre-donation eGFR was 108.7 (82-144) ml/min/1.73 m, and the median (range) post-donation eGFR at 1 year was 86.9 (43-143) ml/min/1.73 m. Eighty-six percent of donors had compensatory hypertrophy. In the univariate analysis, age, female sex, history of hypertension, body surface area, and pre-donation eGFR were significantly associated with hypertrophy (p < 0.05). In the multivariate analysis, age, female sex, history of hypertension, and ratio of the remnant kidney volume to body weight were significantly associated with hypertrophy (p < 0.05). Based on these results, we created a compensation prediction score (CPS). The median (range) CPS was 8.7 (1.1-17.4). Receiver operating characteristic analysis showed strong diagnostic accuracy for predicting favorable compensation (area under the curve, 0.958; 95% confidence interval, 0.925-0.991, p < 0.001). The optimal cut-off value of the CPS was 5.0 (sensitivity, 92.0%; specificity, 89.5%). The CPS had a strong positive correlation with the post-donation eGFR (R = 0.797, p < 0.001).
The CPS might be useful tool with which to predict a favorable compensation of the contralateral kidney and remnant kidney function. If the CPS is low, careful management and follow-up might be necessary. Further investigations are needed to validate these findings in larger populations.
人们熟知活体供肾者捐肾后对侧肾脏功能的代偿情况，并且已经提出了许多预测因素。然而，目前尚未提出预测模型。本研究旨在建立一种工具，以评估活体供肾者捐肾后对侧肾脏的代偿程度。
我们回顾性分析了本机构 133 例接受肾移植的活体供者。我们将 1 年后（通过慢性肾脏病流行病学协作公式计算）的估算肾小球滤过率（eGFR）较供肾前增加>60%定义为良好的代偿。我们分析了活体供者的临床特征和结局。
中位（范围）供者年龄为 59（24-79）岁，中位（范围）体重指数为 22.9（16.8-32.7）kg/m²，中位（范围）体表面积为 1.6（1.3-2.0）m²。所有供者均为日本人，其中 73%为生物学相关供者。中位（范围）供者供肾前 eGFR 为 108.7（82-144）ml/min/1.73m²，中位（范围）供肾后 1 年 eGFR 为 86.9（43-143）ml/min/1.73m²。86%的供者存在代偿性肥大。单因素分析显示，年龄、女性、高血压病史、体表面积和供肾前 eGFR 与肥大显著相关（p<0.05）。多因素分析显示，年龄、女性、高血压病史和残肾体积与体重比与肥大显著相关（p<0.05）。基于这些结果，我们创建了一个代偿预测评分（CPS）。中位（范围）CPS 为 8.7（1.1-17.4）。受试者工作特征分析显示，该评分对预测良好的代偿具有很强的诊断准确性（曲线下面积为 0.958；95%置信区间为 0.925-0.991，p<0.001）。CPS 的最佳截断值为 5.0（灵敏度为 92.0%；特异性为 89.5%）。CPS 与供肾后 eGFR 呈强正相关（R=0.797，p<0.001）。
CPS 可能是一种有用的工具，可以预测对侧肾脏和残肾功能的良好代偿。如果 CPS 较低，可能需要谨慎管理和随访。需要进一步的研究来验证这些发现是否适用于更大的人群。
