The Utility of Split Function Testing in Determining Recovery of Glomerular Filtration Rate After Living Kidney Donation: a Cohort Study

Overview

Journal BMC Nephrol

Publisher Biomed Central

Date 2025 Jan 18

PMID 39827110

Authors

Kirsty J Crowe

Siobhan K McManus

Julie A Glen

Karen S Stevenson

Ian M McLaughlin

Alice Nicol

Colin C Geddes

Affiliations

Soon will be listed here.

Abstract

Background: A number of UK transplantation centres use isotope studies to estimate the relative contribution from each kidney in living kidney donor assessment. The evidence that the estimation of pre-donation split function of the non-donated kidney influences post-donation renal recovery is limited. The aim of this study was to analyse whether, in the context of other donor factors, the split function of the non-donated kidney predicts the percentage recovery of glomerular filtration rate (GFR) at one-year post-donation.

Methodology: A retrospective cohort analysis was undertaken on 291 living kidney donors in the Glasgow Renal and Transplant Unit between 1 January 2011 and 1 June 2022. Univariable and multivariable linear regression analysis was used to analyse the impact of donor factors on recovery of renal function at one year relative to baseline isotope GFR (iGFR) or to estimated GFR (eGFR by Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] formula). Sub-analyses of donor outcome (% recovery of iGFR and eGFR at one year) were undertaken using single-measures ANOVA and grouping of donors by pre-donation isotope uptake of the non-donated kidney.

Results: Median recovery of pre-donation GFR at 1 year was 70.0% (IQR 64.8-75.5). On linear regression analysis there was no significant association found between split function of the non-donated kidney and the percentage recovery of iGFR, although a small significant association was found for eGFR. There was no significant difference between mean iGFR or eGFR recovery on sub-analysis of donor outcomes.

Conclusions: This study demonstrated no clinically important predictive relationship between percentage recovery of renal function at 1 year after living kidney donation and pre-donation split function within the range accepted for donation in our centre.

References

van Londen M, van der Weijden J, Niznik R, Mullan A, Bakker S, Berger S . Prediction of measured GFR after living kidney donation from pre-donation parameters. Nephrol Dial Transplant. 2022; 38(1):212-221. PMC: 9869859. DOI: 10.1093/ndt/gfac202. View

Harper K, Salameh J, Akhlaq N, McInnes M, Ivankovic V, Beydoun M . The impact of measuring split kidney function on post-donation kidney function: A retrospective cohort study. PLoS One. 2021; 16(7):e0253609. PMC: 8253423. DOI: 10.1371/journal.pone.0253609. View

Eum S, Lee H, Ko E, Cho H, Yang C, Chung B . Comparison of CT volumetry versus nuclear renography for predicting remaining kidney function after uninephrectomy in living kidney donors. Sci Rep. 2022; 12(1):5144. PMC: 8948196. DOI: 10.1038/s41598-022-09187-9. View

Lenihan C, Busque S, Derby G, Blouch K, Myers B, Tan J . Longitudinal study of living kidney donor glomerular dynamics after nephrectomy. J Clin Invest. 2015; 125(3):1311-8. PMC: 4362245. DOI: 10.1172/JCI78885. View

Delanaye P, Weekers L, Dubois B, Cavalier E, Detry O, Squifflet J . Outcome of the living kidney donor. Nephrol Dial Transplant. 2012; 27(1):41-50. DOI: 10.1093/ndt/gfr669. View

Bellini M, Charalampidis S, Stratigos I, Dor F, Papalois V . The Effect of Donors' Demographic Characteristics in Renal Function Post-Living Kidney Donation. Analysis of a UK Single Centre Cohort. J Clin Med. 2019; 8(6). PMC: 6616400. DOI: 10.3390/jcm8060883. View

Habbous S, Garcia-Ochoa C, Brahm G, Nguan C, Garg A . Can Split Renal Volume Assessment by Computed Tomography Replace Nuclear Split Renal Function in Living Kidney Donor Evaluations? A Systematic Review and Meta-Analysis. Can J Kidney Health Dis. 2019; 6:2054358119875459. PMC: 6753513. DOI: 10.1177/2054358119875459. View

Akoh J, Schumacher K . Living kidney donor assessment: Kidney length differential function. World J Transplant. 2020; 10(6):173-182. PMC: 7360526. DOI: 10.5500/wjt.v10.i6.173. View

Inker L, Eneanya N, Coresh J, Tighiouart H, Wang D, Sang Y . New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med. 2021; 385(19):1737-1749. PMC: 8822996. DOI: 10.1056/NEJMoa2102953. View

10.

Bellini M, Nozdrin M, Pengel L, Knight S, Papalois V . Risks for donors associated with living kidney donation: meta-analysis. Br J Surg. 2022; 109(8):671-678. PMC: 10364766. DOI: 10.1093/bjs/znac114. View

11.

Fleming J, Zivanovic M, Blake G, Burniston M, Cosgriff P . Guidelines for the measurement of glomerular filtration rate using plasma sampling. Nucl Med Commun. 2004; 25(8):759-69. DOI: 10.1097/01.mnm.0000136715.71820.4a. View

12.

Seo W, Lee C, Park T, Kim W, Min K, Chung J . Role of Prior Split Renal Function for Living Kidney Transplantation in Recipients and Donors. Transplant Proc. 2020; 52(10):3002-3008. DOI: 10.1016/j.transproceed.2020.05.012. View

13.

Lentine K, Kasiske B, Levey A, Adams P, Alberu J, Bakr M . KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017; 101(8S Suppl 1):S1-S109. PMC: 5540357. DOI: 10.1097/TP.0000000000001769. View

14.

Rook M, Hofker H, van Son W, van der Heide J, Ploeg R, Navis G . Predictive capacity of pre-donation GFR and renal reserve capacity for donor renal function after living kidney donation. Am J Transplant. 2006; 6(7):1653-9. DOI: 10.1111/j.1600-6143.2006.01359.x. View

15.

van der Weijden J, Mahesh S, van Londen M, Bakker S, Sanders J, Navis G . Early increase in single-kidney glomerular filtration rate after living kidney donation predicts long-term kidney function. Kidney Int. 2022; 101(6):1251-1259. DOI: 10.1016/j.kint.2022.01.034. View

16.

Okumura K, Yamanaga S, Tanaka K, Kinoshita K, Kaba A, Fujii M . Prediction model of compensation for contralateral kidney after living-donor donation. BMC Nephrol. 2019; 20(1):283. PMC: 6660650. DOI: 10.1186/s12882-019-1464-1. View