Kyaw Lin, Peng Hong Min, Ong Simone Meiqi, Goh Benjamin, Lu Jirong, Tiong Ho Yee
Department of Urology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
World J Urol. 2025 Apr 28;43(1):256. doi: 10.1007/s00345-025-05653-x.
Removing the smaller kidney for donor nephrectomy has been advocated if there is a size difference of ≥ 10% after other anatomical considerations. This study reports the difference in long-term renal function in patients who have their larger kidney removed for donor nephrectomy.
Data of 104 donors were prospectively collected. They were divided into 2 groups depending on donated kidney being ≥ 10% larger (Group-1) or < 10% larger (Group-2) than the remaining kidney. Baseline characteristics (age, gender, BMI, surgical details, co-morbidities), estimated Glomerular Filtration Rate (eGFR, calculated using CKD-EPI formula) before and up to 5-years after surgery were collected.
Group 1 (n = 28) and Group 2 (n = 76) had similar baseline characteristics. The split renal volume (SRV) of donated kidney was 53.4% (52.5-58.7%) for Group 1 and 49.9% (44.3-52.5%) for Group 2 eGFR between 2 groups were similar (110.7 ± 20.8 vs 103.4 ± 22.5, p = 0.14). eGFR was not different at 6-months, 1-, 3- and 5-year post-operation. Patients with eGFR < 60 was also not significantly different between the 2 groups 23.1% vs 31.4% (p = 0.42). Group-1 had significantly greater absolute reduction in eGFR than Group-2 (45.5 ± 17.8 vs 37.6 ± 14.5, p = 0.02) at 6-months post op. After which, there was a steady improvement in eGFR up to 5-years; which was most significant from the 6-months to 1-year (p = 0.02, 0.001). The absolute and relative recovery in eGFR beyond 6-months does not differ significantly.
Despite an initial greater decrease in eGFR at 6 months, removing the larger kidney (> 10% absolute difference within the SRV limits of this study) for donor nephrectomy did not result in a significant difference in kidney function at 5 years due to similar rates of eGFR recovery after nadir levels at 6 months.
如果在考虑其他解剖因素后，两侧肾脏大小差异≥10%，则有人主张在供肾切除术中切除较小的肾脏。本研究报告了在供肾切除术中切除较大肾脏的患者的长期肾功能差异。
前瞻性收集了104名供体的数据。根据捐赠肾脏比剩余肾脏大≥10%（第1组）或大<10%（第2组），将他们分为两组。收集基线特征（年龄、性别、体重指数、手术细节、合并症），以及手术前和手术后长达5年的估计肾小球滤过率（eGFR，使用CKD-EPI公式计算）。
第1组（n = 28）和第2组（n = 76）具有相似的基线特征。第1组捐赠肾脏的分肾体积（SRV）为53.4%（52.5 - 58.7%），第2组为49.9%（44.3 - 52.5%）。两组之间的eGFR相似（110.7±20.8对103.4±22.5，p = 0.14）。术后6个月、1年、3年和5年时eGFR无差异。两组中eGFR<60的患者也无显著差异，分别为23.1%对31.4%（p = 0.42）。术后6个月时，第1组的eGFR绝对降低幅度显著大于第2组（45.5±17.8对37.6±14.5，p = 0.02）。此后，eGFR在长达5年的时间里稳步改善；从6个月到1年改善最为显著（p = 0.02，0.001）。6个月后eGFR的绝对和相对恢复无显著差异。
尽管术后6个月时eGFR最初下降幅度较大，但由于6个月最低点水平后eGFR恢复率相似，在供肾切除术中切除较大的肾脏（在本研究的SRV范围内绝对差异>10%）在5年时肾功能并无显著差异。
