Change in renal function following laparoscopic donor nephrectomy using 99 mTc-diethylenetriaminepentaacetic acid scan
Change in renal function following laparoscopic donor nephrectomy using 99 mTc-diethylenetriaminepentaacetic acid scan
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DOI：
10.1007/s00345-014-1408-0
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发表时间：
2015-05-01
影响因子：
3.4
通讯作者：
Hwang, Tae-Kon
中科院分区：
文献类型：
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作者：
Cho, Hyuk Jin;Choi, Sae Woong;Hwang, Tae-Kon
我们使用连续的锝99 m二乙烯三胺五乙酸（DTPA）扫描评估了腹腔镜供体肾切除术后剩余肾功能的变化，并调查了影响病程的因素。所有供体均在术前、术后1个月、6个月和1年进行连续DTPA扫描。我们研究了术后肾功能的纵向变化，并分析了影响围手术期肾小球滤过率（GFR）变化的参数。根据DTPA扫描，GFR的变化在捐赠后1个月至2年期间有显著改善（所有p < 0.001）。术后1个月和1年，剩余肾脏的DTPA-GFR分别增加了14.8%至58.2 +/- A 10.6 ml/min/1.73 m（2）（p < 0.001）和33.9%至78.0 +/- A 14.0 ml/min/1.73 m（2）（p < 0.001）。根据DTPA-GFR，仅21.9%的3期或3期以上慢性肾脏病（CKD）供体在捐献后1年时< 60 ml/min/1.73 m2。多因素回归分析显示，患者年龄（p = 0.005）、BMI（p = 0.04）、术前残肾DTPA-GFR（p = 0.009）与术后1年DTPA-GFR的增加呈负相关，术后2年残肾DTPA-GFR持续增加。体重指数较低的年轻供体和剩余肾脏初始功能较低的供体在肾切除术后表现出DTPA-GFR更大的增加。根据DTPA-GFR的结果，许多献血后CKD 3期的供体具有良好的肾功能。
We assessed the change in remaining kidney function after laparoscopic donor nephrectomy using serial technetium 99m diethylenetriaminepentaacetic acid (DTPA) scans and investigated the factors affecting the course.Data from 155 donors were obtained from a prospectively maintained database. All donors underwent consecutive DTPA scans preoperatively and 1 month, 6 months and 1 year postoperatively. We investigated the longitudinal change in renal function after surgery and analyzed parameters to influence the perioperative glomerular filtration rate (GFR) change.The changes in GFR according to the DTPA scan presented significant improvement from 1 month up to 2 years after donation (all p < 0.001). The DTPA-GFR of the remaining kidney increased by 14.8 % to 58.2 +/- A 10.6 ml/min/1.73 m(2) (p < 0.001) and by 33.9 % to 78.0 +/- A 14.0 ml/min/1.73 m(2) at 1 month and 1 year after surgery, respectively (p < 0.001). Only 21.9 % of donors categorized into chronic kidney disease (CKD) stage 3 or more at 1 year after donation were < 60 ml/min/1.73 m(2) according to DTPA-GFR. Multivariate regression analysis revealed that the increase in DTPA-GFR at 1 year was negatively associated with patient age (p = 0.005), BMI (p = 0.04) and preoperative DTPA-GFR of remaining kidney (p = 0.009).The DTPA-GFR of remaining kidney increased steadily for up to 2 years after surgery. Younger donors with lower body mass index and those with lower initial function of the remaining kidney demonstrated a greater increase in DTPA-GFR after nephrectomy. Many of the donors with CKD stage 3 after donation have good renal function according to the results of DTPA-GFR.