Live Donor Renal Anatomic Asymmetry and Posttransplant Renal Function

Area of Science:

• Nephrology
• Transplant Surgery
• Radiology

Background:

• Live donor kidney transplantation is crucial for end-stage renal disease.
• Donor renal anatomic asymmetry's impact on transplant outcomes is understudied.
• Assessing split renal function is vital for predicting graft success.

Purpose of the Study:

• To investigate the relationship between donor renal anatomic asymmetry and posttransplant recipient kidney function.
• To identify key predictors of recipient estimated glomerular filtration rate (eGFR) at one year.
• To evaluate the utility of CT-based volume calculations versus traditional renography for split renal function assessment.

Main Methods:

• Analysis of 96 live kidney donors with anatomical asymmetry (>10% renal length/volume difference) and their recipients.
• Quantification of split function differences (SFD) using technetium-dimercaptosuccinic acid renography.
• Development of a predictive model incorporating donor renal volume adjusted to recipient weight (Vol/Wgt), SFD, and biopsy scores to estimate 1-year recipient eGFR.

Main Results:

• Donor renal volume adjusted to recipient weight (Vol/Wgt) was strongly correlated with split renal function (r=0.79, P<0.001).
• Vol/Wgt was the only significant predictor of higher odds of achieving eGFR > 60 mL/min/1.73 m(2) at 1 year (OR=8.94, P=0.001).
• Vol/Wgt demonstrated strong discriminatory power in predicting the risk of eGFR < 60 mL/min/1.73 m(2) (ROC curve=0.78).

Conclusions:

• Donor renal volume adjusted to recipient weight (Vol/Wgt) is a major determinant of recipient kidney function one year post-transplant in cases of renal asymmetry.
• CT-based volume calculations can effectively replace renography for estimating split renal function.
• This finding has implications for donor selection and surgical planning in kidney transplantation.