Measurement of renal function reserve may be useful in kidney donor selection
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Renal function reserve was more significantly reduced in kidney donors with certain characteristics, making it a potentially useful tool for assessing donor risk pre-transplant, according to this study.
“The kidney’s capacity to increase its glomerular filtration rate in response to a higher functional demand is known as the renal functional reserve (RFR),” Andreja Figurek, MD, PhD, of the University of Zurich, in Switzerland, and colleagues wrote. "Good short-term outcomes after living kidney donation have led to more acceptance of borderline donors (with hypertension, obesity, older age) due the ongoing shortage of donor organs. Given recent concerns about increased long-term risk in some donor subgroups better donor stratification is needed.”
Suggesting that measurement of RFR could inform assessment of donor risk, researchers conducted a systematic literature review and considered 16 studies published between 1956 and 2019 (including pre- and post-donation data for 1,425 donors).
Analysis of RFR pre- and post-donation revealed RFR was reduced in all donors after donation, though shorter-term RFR was mostly preserved in “young healthy donors.” A greater reduction in RFR was found in donors of an older age or who were overweight or had hypertension.
Researchers noted there were not enough data to determine whether post-donation RFR differed between male and female donors. Further, they wrote that it remains uncertain whether RFR could be useful in predicting long-term function in living donors, as their analysis included a small number of studies that were cross-sectional in nature and lacked long-term follow-up and ethnic diversity.
However, they argued, “this weakness ... is in itself a strength as it strongly highlights the need for good prospective studies going forward,” adding “very few studies were identified that measured GFR, [effective renal plasma flow] EPFR and RFR over the last 6 decades.”
They suggested it is important to continue evaluating the utility of RFR testing as part of the assessment process for living kidney donors. – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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