腎臟捐贈者之長期追蹤：單一醫學中心15年經驗
葉韶豪、王敘涵、劉冠麟
林口長庚紀念醫院 外科部 泌尿外科
Long-term follow-up of kidney donors: 15 years’ experience at single center
Shao-Hao Yeh, Hsu-Han Wang, Kuan-Lin Liu
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou
Purpose: To investigate preoperative factors that predicting the short-term, mid-term, and long-term renal function in kidney donors after laparoscopic donor nephrectomy.
Materials and Methods: From March 2002 to December 2016, preoperative data of total 101 patients underwent laparoscopic donor nephrectomy were retrospectively analyzed. After laparoscopic donor nephrectomy, serum creatinine concentration and MDRD eGFR were serially followed until postoperative 5 years. Univariate and multivariate linear regression analyses were used to identify independent predictors of postoperative GFR at short-term, mid-term, and long-term (3 months, 1 year, 3 years, and 5 years). In addition, predictors of decreased renal function at postoperative 5 years were assessed through ROC analysis by measuring the area under curve.
Results: Age was a independent predictor of postoperative GFR at short-term, mid-term, and long-term. BMI was a independent predictor of postoperative GFR at mid-term and long-term. Preoperative GFR was a independent predictor of postoperative GFR at short-term and mid-term. Decreased renal function at postoperative 5 years was associated with age, BMI, and preoperative GFR. The best sensitivity and specificity were obtained with a cutoff value of age: 49 years old, BMI: 24.49, preoperative GFR: 77.9 ml/min, for predicting decreased renal function at postoperative 5 years.
Conclusion: Close monitoring of renal function and adequate management should be performed in old, high BMI, and lower preoperative GFR donors. Overweight and obese patients (BMI ≥ 24) may consider
weight reduction before donation due to decreased renal function at postoperative 5 years.