Amat Norshuhada, Lim Jeffery, Rezali Muhammad Solihin, Seevalingam Kanesh, Fadzli Ahmad N, Dublin Norman, Razack Azad, Ong Teng Aik, Kuppusamy Shanggar
Urology Unit, Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Social and Preventive Medicine Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Int Urol Nephrol. 2025 Sep 9. doi: 10.1007/s11255-025-04725-6.
Living donor kidney transplantation is a critical strategy to address the growing burden of end-stage kidney disease (ESKD) in Malaysia. Whilst living donation is generally safe, concerns remain regarding long-term donor outcomes. This study aimed to evaluate renal function and morbidity changes in living kidney donors 1 year post-donation, and to identify predictors of impaired kidney function.
A retrospective cohort study was conducted using clinical records of 230 living kidney donors who underwent nephrectomy at University Malaya Medical Centre between 2003 and 2021. Donor sociodemographic characteristics, comorbidities, and estimated glomerular filtration rate (eGFR) were assessed pre-donation and at 1 year post-donation. Impaired kidney function was defined as eGFR < 90 mL/min/1.73m. Data were analysed using descriptive statistics and multivariate logistic regression.
At 1 year post-donation, 76.2% of donors exhibited impaired kidney function. Additionally, the proportion of donors with diabetes and dyslipidaemia increased significantly post-donation. Male sex and increasing age were significant predictors of reduced eGFR. Ethnic Chinese and 'Others' ethnicities were found to have a lower risk of impaired renal function compared to Malays. No significant association was found between baseline comorbidity status and post-donation eGFR.
The study highlights the importance of age, gender, and ethnicity in predicting renal outcomes post-donation. These findings underscore the need for standardised pre-donation screening and structured post-donation surveillance. Strengthening clinical protocols and policy frameworks is essential to ensure donor safety and the sustainability of living donor transplantation in Malaysia.
活体供肾移植是应对马来西亚终末期肾病（ESKD）负担日益加重的一项关键策略。虽然活体捐赠总体上是安全的，但对捐赠者的长期预后仍存在担忧。本研究旨在评估活体肾捐赠者在捐赠后1年的肾功能和发病率变化，并确定肾功能受损的预测因素。
采用回顾性队列研究，使用2003年至2021年间在马来亚大学医学中心接受肾切除术的230名活体肾捐赠者的临床记录。在捐赠前和捐赠后1年评估捐赠者的社会人口统计学特征、合并症和估计肾小球滤过率（eGFR）。肾功能受损定义为eGFR < 90 mL/min/1.73m²。使用描述性统计和多变量逻辑回归分析数据。
捐赠后1年，76.2% 的捐赠者出现肾功能受损。此外，捐赠后患有糖尿病和血脂异常的捐赠者比例显著增加。男性和年龄增长是eGFR降低的显著预测因素。与马来人相比，华裔和“其他”族裔的肾功能受损风险较低。未发现基线合并症状态与捐赠后eGFR之间存在显著关联。
该研究强调了年龄、性别和种族在预测捐赠后肾脏预后方面的重要性。这些发现强调了进行标准化捐赠前筛查和结构化捐赠后监测的必要性。加强临床方案和政策框架对于确保马来西亚活体捐赠者的安全和活体供肾移植的可持续性至关重要。
