Influence of Renal Function by Transplant Operation for Living-Related Kidney Donors in the Short Term
Kidney transplantation remains a cornerstone in treating end-stage renal disease (ESRD), with living donor kidneys offering superior outcomes in graft and patient survival compared to deceased donors. Despite the clinical success of living-related kidney donations (LKDs), concerns persist about the long-term health consequences for donors, including the risk of developing ESRD. While short-term risks for LKDs are generally considered low, comprehensive evaluations of renal function and quality of life post-donation are critical to ensuring donor safety. This study investigates the short-term impact of nephrectomy on renal function and health-related quality of life in LKDs, providing valuable insights into postoperative outcomes.
Study Design and Participant Characteristics
The research included 120 LKDs recruited from the Kidney Transplantation Center of West China Hospital, Sichuan University, between July 2014 and June 2016. Participants underwent nephrectomy within the preceding year and were aged 18–65 years (mean age: 46.7 ± 10.2 years). Donors were predominantly female (76.7%) and related to recipients as parents (56.7%) or siblings (23.3%). All procedures adhered to standardized protocols, including preoperative assessments of ABO blood group compatibility, human leukocyte antigen (HLA) matching, and physical evaluations to exclude contraindications. Nephrectomies were performed via open surgery (removal through the 12th rib) or minimally invasive laparoscopy.
Quality of Life Assessment
The SF-36 Health Survey evaluated eight domains of health-related quality of life: physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE), and mental health (MH). Scores were transformed to a 0–100 scale, with higher values indicating better outcomes. Post-donation SF-36 scores for LKDs were compared to normative data from urban and rural populations in Sichuan Province.
Results revealed no significant differences between LKDs and the general population across all domains (PF: 89.42 vs. 90.62; RP: 67.08 vs. 79.51; BP: 81.04 vs. 85.61; GH: 67.13 vs. 69.55; VT: 77.25 vs. 70.29; SF: 91.67 vs. 86.85; RE: 77.22 vs. 76.45; MH: 78.97 vs. 72.65). The findings suggest that nephrectomy did not detrimentally affect donors’ physical or mental well-being in the short term.
Renal Function Evaluation
To assess renal function, 24 biochemical and physiological parameters were analyzed before and after donation. Estimated glomerular filtration rate (eGFR), a key indicator of kidney function, declined significantly from a preoperative median of 99.03 mL·min⁻¹·1.73 m⁻² to 72.34 mL·min⁻¹·1.73 m⁻² postoperatively (P < 0.001). However, post-donation eGFR values remained above the threshold for chronic kidney disease (CKD) stage 3 (eGFR < 60 mL·min⁻¹·1.73 m⁻²).
Other notable changes included reductions in serum creatinine (preoperative median: 87.8 μmol/L vs. postoperative: 63.7 μmol/L; P < 0.001), uric acid (312.0 μmol/L vs. 263.5 μmol/L; P < 0.001), and blood glucose (5.29 mmol/L vs. 5.13 mmol/L; P = 0.001). Conversely, increases were observed in cholesterol (4.53 mmol/L vs. 4.97 mmol/L; P < 0.001) and globulin levels (27.62 g/L vs. 29.81 g/L; P = 0.005). While 18 of 24 parameters showed statistically significant differences, most postoperative values remained within or slightly below normal clinical ranges.
Age-Related Variations in Renal Outcomes
Subgroup analyses compared middle-aged (45–59 years) and elderly (≥60 years) donors. Elderly donors exhibited smaller declines in alanine aminotransferase (ALT) post-donation (–1.0 IU/L vs. –4.0–8.0 IU/L; P = 0.036) but greater reductions in eGFR (–24.22 mL·min⁻¹·1.73 m⁻² vs. –32.69 mL·min⁻¹·1.73 m⁻²; P = 0.018). Despite these differences, age did not significantly alter other renal function markers or quality of life outcomes, underscoring the procedure’s feasibility across age groups.
Clinical Implications and Follow-Up
The transient decline in eGFR and mild metabolic shifts post-donation highlight the importance of regular monitoring. Proteinuria emerged in some donors, emphasizing the need for long-term surveillance to detect early signs of renal impairment. Elevated post-donation blood glucose and aspartate transferase (AST) levels suggest potential risks for hyperglycemia and hepatic stress, necessitating dietary and lifestyle counseling.
No major complications, such as wound infections, bleeding, hypertension, or anemia, were reported. However, the absence of severe adverse effects in the short term does not negate the need for structured follow-up protocols. Current guidelines recommend biannual or annual evaluations of blood pressure, urinalysis, and biochemical profiles to ensure donor safety.
Conclusion
This study demonstrates that living kidney donation does not compromise short-term quality of life, with SF-36 scores comparable to those of the general population. Although nephrectomy induces significant changes in renal function indicators, most values remain within normal limits, supporting the safety of the procedure. Age-related variations in eGFR and ALT warrant tailored monitoring for elderly donors.
Long-term studies are essential to validate these findings and address potential late-onset complications. Regular follow-up, patient education, and preventive care are pivotal to optimizing donor outcomes and sustaining the ethical integrity of living-related kidney transplantation programs.
doi.org/10.1097/CM9.0000000000000080
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