Tanaka Ryo, Taniguchi Ayumu, Higa-Maegawa Yoko, Matsumura Soichi, Fukae Shota, Nakazawa Shigeaki, Kakuta Yoichi, Nonomura Norio
Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka 565-0871, Japan.
Department of Urology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka Urayasu, Chiba 279-0021, Japan.
J Clin Med. 2024 Nov 23;13(23):7090. doi: 10.3390/jcm13237090.
: The accurate prediction of postoperative renal function (post-RF) in living kidney donors is essential for optimizing donor safety and long-term health. After nephrectomy, renal function can be significantly altered, owing to the functional adaptation of the remaining kidney; however, the extent of this has not been investigated. This study aimed to examine how various donor factors affect functional adaptation after nephrectomy, and to develop a new predictive model. : In total, 310 patients who underwent donor nephrectomy were included. Preoperative split renal function (pre-SRF) of the remaining kidney was measured. Post-RF was measured 1 month after surgery. The functional adaptation rate was calculated from the difference between pre-SRF and post-RF. Multiple regression analysis was performed to develop a predictive formula for post-RF, incorporating donor age and pre-SRF. : The median age of the donors was 60 years, and 38.7% were men. The median pre-SRF was 36.4 mL/min/1.73 m. The median functional adaptation rate was 26.8%, with donor age, pre-SRF, and a history of hyperuricemia (HUA) being significant predictors of the functional adaptation rate. The equation for post-RF was established as 0.94 × pre-SRF - 0.12 × age + 18.87 mL/min/1.73 m. The estimated post-RF showed a high coefficient of determination (R = 0.76), with a mean bias of -0.01 mL/min/1.73 m. : Donor age, pre-SRF, and HUA are key predictors of renal functional adaptation after nephrectomy. The developed formula accurately estimates post-RF, supporting clinical decision-making and donor counseling for living kidney donations.
准确预测活体肾供者术后肾功能对于优化供者安全性和长期健康至关重要。肾切除术后，由于剩余肾脏的功能适应性变化，肾功能可能会发生显著改变；然而，其变化程度尚未得到研究。本研究旨在探讨各种供者因素如何影响肾切除术后的功能适应性，并建立一种新的预测模型。
总共纳入了310例行供肾切除术的患者。测量了剩余肾脏术前的分肾功能（pre-SRF）。术后1个月测量术后肾功能（post-RF）。根据pre-SRF与post-RF之间的差异计算功能适应率。进行多元回归分析以建立post-RF的预测公式，纳入供者年龄和pre-SRF。
供者的中位年龄为60岁，38.7%为男性。pre-SRF的中位数为36.4 mL/min/1.73 m²。功能适应率的中位数为26.8%，供者年龄、pre-SRF和高尿酸血症（HUA）病史是功能适应率的显著预测因素。post-RF的方程确定为0.94×pre-SRF - 0.12×年龄 + 18.87 mL/min/1.73 m²。估计的post-RF显示出较高的决定系数（R = 0.76），平均偏差为-0.01 mL/min/1.73 m²。
供者年龄、pre-SRF和HUA是肾切除术后肾功能适应的关键预测因素。所建立的公式能准确估计post-RF，有助于活体肾移植的临床决策和供者咨询。
