Immediate and early renal function after living donor transplantation

Area of Science:

• Nephrology
• Transplantation Immunology
• Surgical Innovation

Background:

• Assessing immediate renal function post-living donor transplantation is crucial.
• Comparison of renal function between allograft recipients and donors within 24 hours.
• Focus on early graft performance and donor kidney status.

Purpose of the Study:

• To evaluate the immediate renal function of living donor kidney allografts.
• To compare graft function with the remaining donor kidney function post-transplantation.
• To identify factors influencing early post-transplant renal recovery.

Main Methods:

• Intraoperative volume loading with Ringer's acetate and mannitol.
• Administration of frusemide to promote diuresis.
• Estimation of glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) using inulin and p-aminohippurane clearances.
• Assessment of tubular function and injury via lithium clearance, fractional sodium excretion, and N-acetyl-beta-glucosaminidase excretion.

Main Results:

• Graft GFR and ERPF were approximately 30% lower than donor kidneys at 1 hour post-surgery.
• Renal function parameters normalized to similar levels as donor kidneys within 3 hours.
• Minimal tubular dysfunction and injury observed in grafts, with normalization trends within 24 hours.

Conclusions:

• The described transplantation procedure, featuring short ischemia time and aggressive fluid management, promotes rapid renal function recovery.
• Combined use of mannitol and frusemide contributes to improved early graft function.
• Living donor kidneys can achieve near-normal function within hours post-transplantation with this protocol.