The Early Effects of Kidney Donation in Living Kidney Donors

Introduction Kidney transplantation is the preferred treatment option for end stage kidney disease. Living kidney donation is an established form of organ donation with the added risk of an unnecessary surgery in a normal individual. These donors remain at an increased risk of multiple medical problems for the rest of their life. In this study, we evaluated the early effects of donor-nephrectomy among living kidney donors during the period of post-transplant hospital stay. Materials and Methods This cross-sectional study was done at a tertiary care hospital of a developing country from January 2006 to June 2017. All kidney donors who had undergone graft nephrectomy during the study period were the study population. All the donors underwent Tc-99m diethylene triamine pentaacetic acid (Tc-99m DTPA) renogram for measurement of glomerular filtration rate (GFR). GFR was also estimated by chronic kidney disease epidemiology collaboration (CKD-EPI) 2009 equation, in both pre- and post- kidney donation periods. Results Total number of subjects was 94 (male:female=1.3:1) with mean age 37.2 ± 10.5 years and mean postoperative hospital stay 8.2 ± 1.9 days. The mean pre-operative measured glomerular filtration rate (mGFRDTPA) was 96.6 ± 18.7 mL/min/1.73 m2 and mean estimated glomerular filtration rate (eGFRCKD-EPI) was 97.6 ± 17.9 mL/min/1.73 m2 (p=0.709). In post-nephrectomy period mean urine output decreased from 2713.8 ± 804.8 to 2243.7 ± 674.1 mL/day (p=0.000). Mean systolic blood pressure and diastolic blood pressure was lowered from 120.1 ± 12.2 to 115.9 ± 10.2 mm of Hg (p=0.001) and 77.5 ± 7.0 to 75.5 ± 7.6 mm of Hg (p=0.036) respectively, after nephrectomy. There was significant increase in blood urea (from 20.2 ± 5.8 to 30.0 ± 9.5 mg/dL, p=0.000) and serum creatinine (from 0.89 ± 0.15 to 1.25 ± 0.27 mg/dL, p=0.000) in post kidney donation period. Only 7 (7.45%) had blood urea level above the normal value (>40mg/dl) but 44 (46.81%) had mildly raised serum creatinine level (>1.2 mg/dl). Mean mGFRDTPA of the subjects of non-nephrectomized kidney of the donors was 47.6 ± 9.4 mL/min/1.73 m2 and mean eGFRCKD-EPI of same kidneys was 68.5 ± 17.4 mL/min/1.73m2 (p=0.000) after nephrectomy. Conclusion Donor nephrectomy in healthy living kidney donors has early impacts on blood pressure and deleterious effects on urine output, blood urea and serum creatinine levels. Key words: Donor nephrectomy, estimated GFR, living kidney donors, measured GFR.