Residual kidney function after donor nephrectomy

Summary:

Aim: We evaluated the long-term residual renal function after donor nephrectomy using ^99mTc-mercaptoacetyltriglycin (MAG3)-clearance. Donors, methods: Altogether 49 kidney donors were examined using ^99mTc-MAG3-clearance after nephrectomy for donation to a relative (m:f = 11:38; age 55±27 years). The donors were examined 16±8 years postoperatively (1.5-26 years). 42 donors (86%) showed normal creatinine values, whereas the other seven (14%) exhibited slightly elevated levels. 20 donors were examined pre- and postoperatively and compared intraindividually. The kidney function was compared to the age adapted normal values of healthy persons with two kidneys (67–133% of age related mean). Results: After nephrectomy all donors showed a normal perfusion, good secretion, merely physiological intrarenal transit and a normal elimination from the kidneys. The ^99mTc-MAG3-clearance was 69 ±15% of the normal mean value of healthy carriers of two kidneys regardless of the gender. 20 donors with a preoperative examination showed a significantly reduced total renal function from 84 ± 15% of the mean normal value preoperatively to 60 ± 15% postoperatively (p <0.0005). 15 donors of this group exhibited a significant functional increase of the residual kidney from 40% initially to 60% after nephrectomy (p = 0.003). No correlation was found between the initial ^99mTc-MAG3-clearance measured prior to nephrectomy and the clearance levels after nephrectomy. Also, no correlation between the preoperative ^99mTc- MAG3-clearance and the postoperative serum creatinine values could be observed. Altogether, 22% of the donors (11/49) developed arterial hypertension 10 ± 8 years after donation (1-23 years). This corresponds to the normal age prevalence of hypertension in the carriers of two kidneys. Three donors suffered from arterial hypertension prior to the operation. Conclusion: Kidney donors with normal or slightly elevated creatinine values postoperatively show a ^99mTc- MAG3-clearance value of 69% of the mean value of healthy carriers of two kidneys. This may serve as a reference value for healthy carriers of one kidney. In our study we demonstrated a good compensation of the contralateral kidney via renal scintigraphy by means of ^99mTc-MAG3-clearance.

Zusammenfassung:

Ziel: In unserer Studie wurde die Langzeitresidualnierenfunktion von Spendern nach Uninephrektomie mittels ^99mTc-Mercaptoacetyltriglycin (MAG3)-Clearance untersucht. Spender, Methoden: Insgesamt wurden 49 Spender nach Nierenspende (m : w = 11 : 38, Alter 55 ± 27 Jahre) 16 ± 8 Jahre postoperativ (1,5-26 Jahre) untersucht. Von ihnen zeigten 42 Spender (86%) normwertige und 7 Spender (14%) leicht erhöhte Kreatininwerte. 20 Spender konnten mittels prä- und postoperativer Verlaufskontrollen intraindividuell verglichen werden. Die errechnete Nierenfunktion wurde mit der altersentsprechenden Norm für gesunde Träger zweier Nieren (67-133%) verglichen. Ergebnisse: Alle untersuchten Nierenspender zeigten eine gute Perfusion, eine gute sekretorische Leistung, einen nahezu unauffälligen intrarenalen Transit sowie eine normale Exkretion. Die MAG3-Clearance betrug 69 ± 15% des altersentsprechenden Mittelwertes für gesunde Träger zweier Nieren. 20 Spender, die prä- und postoperativ untersucht wurden, zeigten eine signifikante Reduktion der Clearance-Werte von präoperativ 84 ± 15% der normalen altersentsprechenden Norm auf 60 ±15% (p <0,0005). 15 Spender dieser Gruppe zeigten eine signifikante Nierenfunktionszunahme von initial 40% auf 60% nach Nephrektomie (p = 0,003). Es ergab sich keine Korrelation zwischen der präoperativen ^99mTc-MAG3-Gesamtclearance und den postoperativen Clearance-Werten. Darüber hinaus ergab sich keine Korrelation zwischen der präoperativen ^99mTc-MAG3-Clearance und den postoperativen Serumkreatinin-Werten. Insgesamt entwickelten 22% der Spender (11/49) einen arteriellen Hypertonus 10 ± 8 Jahre nach Nephrektomie (1-23 Jahre). Drei Spender wiesen bereits präoperativ eine arterielle Hypertonie auf. Schlussfolgerung: Nierenspender mit normalen Kreatininwerten zeigen postoperativ einen ^99mTc-MAG3-Clearance-Wert von 69% der altersentsprechenden Norm gesunder Träger zweier Nieren. Dieser Mittelwert könnte als Referenzwert für nephrektomierte Patienten gelten. Unsere Daten wiesen eine gute postoperative funktionelle Kompensation der verbliebenen Niere mittels ^99mTc-MAG3-Clearance nach.

Key words:

Kidney function - donor nephrectomy - ^99mTc-MAG3-clearance

Schlüsselwörter:

Nierenfunktion - Donor-Nephrektomie - ^99mTc-MAG3-Clearance

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