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The Impact of Nephrectomy on Living Donors – An Analysis of the Existing Literature

Introduction In kidney transplantation security for the living donor is of utmost importance. An in-depth understanding of the changes induced by donating one kidney is key to decide on the risk of donation and to define guidelines for donor selection. Robust, well-matched long-term studies on donor outcomes, especially regarding donors with medical risk factors, are missing. In addition, studies on adaptive changes in the remaining kidney are rare and the findings are not well recognized. Methods We have performed a detailed literature review of all studies that looked at outcome of living donors (LD) with a special focus on the physiological effects of donation on the remaining kidney. Here we searched and summarized findings on pre- and post-donation glomerular filtration rate (GFR), renal reserve capacity (RRC), effective renal plasma flow (ERPF) in addition to general medical risk and outcome markers. Results Overall 41 studies on LD outcomes with a special focus on physiological changes were found, covering a time period from 1956 to 2017. The primary characteristics of these studies are summarized in the attached table. The analysis shows that studies on the physiology of changes in kidney organs are rare and nearly absent in the last 10 years. They indicate an adaptive increase in ERPF and GFR in the single, remaining kidney after donation, however longer-term follow-up measurements are missing and studies on changes in ‘borderline donors’ are also needed. Recent studies have larger patients’ numbers and better controls, some identify risk groups and factors for donation but overall lack sufficient follow-up times. Conclusion To allow individual risk assessment and improve safety of living kidney donation studies on the physiology of adaptive changes, esp. in borderline donors, and long-term outcome analyses of well-matched patient cohorts are needed. Keywords living donors, kidney donation outcomes, kidney transplantation, renal reserve capacity NCCR Kidney funded by the Swiss National Science Foundation. Figure. No caption available. Figure. No caption available.