Akoh Jacob A, Schumacher Katharina J
Department of Surgery, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, Devon, United Kingdom.
World J Transplant. 2020 Jun 29;10(6):173-182. doi: 10.5500/wjt.v10.i6.173.
The key question in living kidney donor assessment is how best to determine the contribution of each kidney to overall renal function and guide selection of which kidney to donate, ensuring safety of procedure and good outcome for both recipient and donor. It is thought that a length difference > 2 cm may indicate significant difference in function and therefore need for measurement of differential function.
To determine the effect of using kidney length to decide which kidney to donate in a retrospective cohort of potential donors.
All 333 potential living kidney donors between January 2009 and August 2018 who completed assessment were retrospectively evaluated. Donor assessment was performed as per United Kingdom guidelines. Data included age, sex, kidney length (cranio-caudal) obtained by computed tomography/ultrasono-graphy,51-chromium ethylenediamine tetraacetatic acid measured glomerular filtration rate, mercapto acetyl tri glycine split function and vascular anatomy. There were 48 exclusions due to inadequate data or incomplete investigations. Statistical analysis was performed using Excel pivot tables and GraphPad Prism. Correlation between kidney length and differential function was determined with Pearson's correlation coefficient.
Of 285 potential donors included in the study, there were 144 males (mean age 49.9 ± 14.75) and 141 females (mean age 51.2 ± 11.23). Overall, the Pearson's correlation between differences in length and divided function of kidney pairs was 0.1630, = 0.0058. Of 73 with significant difference (> 10%) in divided function, 18 (24.7%) had no difference in kidney length; 54 (74%) had a difference of < 2 cm and only one of > 2 cm. Using a length difference of > 1 cm would only predict significant difference in divided function in 8/34 (23.5%) of cases. Using a difference of > 2 cm as cut off for performing split function would lead to false reassurance in 72 patients (6 had > 20% difference in divided function whereas 66 had 10%-20% difference).
Length difference between kidney pairs alone is not sufficient to replace measurement of divided function. This issue requires a randomised controlled trial to resolve it.
活体肾供体评估中的关键问题是如何最好地确定每个肾脏对整体肾功能的贡献，并指导选择捐献哪一个肾脏，以确保手术安全以及受体和供体都有良好的预后。人们认为，长度差异>2cm可能表明功能存在显著差异，因此需要测量分肾功能。
在一个潜在供体的回顾性队列中，确定使用肾脏长度来决定捐献哪一个肾脏的效果。
对2009年1月至2018年8月期间完成评估的所有333名潜在活体肾供体进行回顾性评估。供体评估按照英国指南进行。数据包括年龄、性别、通过计算机断层扫描/超声检查获得的肾脏长度（颅尾径）、51铬乙二胺四乙酸测量的肾小球滤过率、巯基乙酰三甘氨酸分肾功能以及血管解剖结构。因数据不足或检查不完整排除48例。使用Excel数据透视表和GraphPad Prism进行统计分析。用Pearson相关系数确定肾脏长度与分肾功能之间的相关性。
本研究纳入的285名潜在供体中，男性144名（平均年龄49.9±14.75岁），女性141名（平均年龄51.2±11.23岁）。总体而言，肾脏对之间长度差异与分肾功能的Pearson相关性为0.1630，P = 0.0058。在73名分肾功能有显著差异（>10%）的供体中，18名（24.7%）肾脏长度无差异；54名（74%）长度差异<2cm，只有1名长度差异>2cm。使用>1cm的长度差异仅能在8/34（23.5%）的病例中预测分肾功能的显著差异。以>2cm的差异作为进行分肾功能检查的临界值会使72名患者得到错误的安心结果（6名分肾功能差异>20%，而66名分肾功能差异为10%-20%）。
仅肾脏对之间的长度差异不足以替代分肾功能的测量。这个问题需要通过随机对照试验来解决。
