Department of General Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto, 861-8520, Japan.
Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
BMC Nephrol. 2019 Nov 8;20(1):403. doi: 10.1186/s12882-019-1588-3.
The renal function of the remaining kidney in living donors recovers up to 60~70% of pre-donation estimated-glomerular filtration rate (eGFR) by compensatory hypertrophy. However, the degree of this hypertrophy varies from donor to donor and the factors related to it are scarcely known.
We analyzed 103 living renal transplantations in our institution and divided them into two groups: compensatory hypertrophy group [optimal group, 1-year eGFR ≥60% of pre-donation, n = 63] and suboptimal compensatory hypertrophy group (suboptimal group, 1-year eGFR < 60% of pre-donation, n = 40). We retrospectively analyzed the factors related to suboptimal compensatory hypertrophy.
Baseline eGFRs were the same in the two groups (optimal versus suboptimal: 82.0 ± 13.1 ml/min/1.73m versus 83.5 ± 14.8 ml/min/1.73m, p = 0.588). Donor age (optimal versus suboptimal: 56.0 ± 10.4 years old versus 60.7 ± 8.7 years old, p = 0.018) and uric acid (optimal versus suboptimal: 4.8 ± 1.2 mg/dl versus 5.5 ± 1.3 mg/dl, p = 0.007) were significantly higher in the suboptimal group. The rate of pathological chronicity finding on 1-h biopsy (ah≧1 ∩ ct + ci≧1) was much higher in the suboptimal group (optimal versus suboptimal: 6.4% versus 25.0%, p = 0.007). After the multivariate analysis, the pathological chronicity finding [odds ratio (OR): 4.8, 95% confidence interval (CI): 1.3-17.8, p = 0.021] and uric acid (per 1.0 mg/dl, OR: 1.5, 95% CI: 1.1-2.2, p = 0.022) were found to be independent risk factors for suboptimal compensatory hypertrophy.
Chronicity findings on baseline biopsy and higher uric acid were associated with insufficient recovery of the post-donated renal function.
供体在捐献肾脏后，剩余肾脏通过代偿性肥大，可恢复到预捐前肾小球滤过率（eGFR）的 60%~70%。然而，这种肥大的程度因人而异，其相关因素尚不清楚。
我们分析了本机构的 103 例活体肾移植，将其分为两组：代偿性肥大组[最佳组，1 年 eGFR≥预捐前的 60%，n=63]和代偿性肥大不佳组（不佳组，1 年 eGFR<预捐前的 60%，n=40）。我们回顾性分析了与代偿性肥大不佳相关的因素。
两组的基线 eGFR 相同（最佳组与不佳组：82.0±13.1ml/min/1.73m 与 83.5±14.8ml/min/1.73m，p=0.588）。供体年龄（最佳组与不佳组：56.0±10.4 岁与 60.7±8.7 岁，p=0.018）和尿酸（最佳组与不佳组：4.8±1.2mg/dl 与 5.5±1.3mg/dl，p=0.007）在不佳组中显著更高。1 小时活检中慢性病变发现率（ah≧1∩ct+ci≧1）在不佳组中更高（最佳组与不佳组：6.4%与 25.0%，p=0.007）。经过多因素分析，慢性病变发现[比值比（OR）：4.8，95%置信区间（CI）：1.3-17.8，p=0.021]和尿酸（每增加 1.0mg/dl，OR：1.5，95%CI：1.1-2.2，p=0.022）被发现是代偿性肥大不佳的独立危险因素。
基线活检中的慢性病变发现和更高的尿酸与捐赠后肾功能恢复不足有关。
