献腎ドナーにおける移植前クレアチニンによる評価と移植後腎機能への影響

抄録

Progress in dialysis therapy has widely improved the prognosis of chronically ill dialysis patients, but kidney transplantation is particularly known to improve patient prognosis significantly. However, the shortage of organ transplant donors remains a global issue. Additionally, the donor's pre-transplant serum creatinine (sCr) is a known indicator of post-transplant kidney function, but the time point of sCr measurement has not been sufficiently reported. In this study, we defined 2 time points of pre-transplantation donor sCr measurement: (1) sCr taken just before surgical resection (final sCr) and (2) sCr taken on admission to the hospital (sCr_min). Thus, we investigated the level of pre-transplantation sCr in the donor and post-transplantation renal function in the transplant patients.

In this single-center study, we included 157 patients who underwent donated kidney transplantation between January 1995 and December 2015 at the Department of Surgery, Kidney Center, Tokyo Women's Medical University Hospital. We compared the postoperative renal function with sCr_min and final sCr before transplantation. Donor sCr may be affected by acute renal failure or acute tubular necrosis under various situations, such as reduction in organ blood flow in the period from admission to organ donation. Therefore, donor sCr was highly likely to change depending on the time point in the treatment.

The comparison showed a significant difference between the levels of sCr and postoperative renal function (sCr of more than 1.0 mg/dl and lower). However, there was no correlation between higher final sCr and lower postoperative renal function. We believed that donor sCr_min reflected the original renal function of the donor, and we obtained a significant difference in the multivariate analysis to designate it as a prognostic factor.

We concluded that that sCr_min values are a better reflection of the donor's original renal function as compared to final sCr. Our findings are significant because they address the current research gap on preoperarive sCr values and prove that sCr taken on admission can accurately predict the donor's post-transplant kidney health, which could lead to better post-operative care for the donor.