29 May 2018 : Original article
Impact of Preoperative Abdominal Visceral Adipose Tissue Area and Nutritional Status on Renal Function After Donor Nephrectomy in Japanese Living Donors for Renal TransplantationShunta Hori1ABCDEF*, Makito Miyake1ADE, Yosuke Morizawa1BC, Yasushi Nakai1BD, Kenta Onishi1B, Kota Iida1B, Daisuke Gotoh1B, Satoshi Anai1B, Kazumasa Torimoto1C, Katsuya Aoki1C, Tatsuo Yoneda1DF, Nobumichi Tanaka1DEF, Katsunori Yoshida1DF, Kiyohide Fujimoto1ADE
Ann Transplant 2018; 23:364-376
BACKGROUND: Living kidney donors face the risk of renal dysfunction, resulting in end-stage renal disease, cardiovascular disease, or cerebrovascular disease, after donor nephrectomy. Reducing this risk is important to increasing survival of living donors. In this study, we investigated the effect of preoperative distribution of abdominal adipose tissue and nutritional status on postoperative renal function in living donors.
MATERIAL AND METHODS: Seventy-five living donors were enrolled in this retrospective study. Preoperative unenhanced computed tomography images were used to measure abdominal adipose tissue parameters. Prognostic nutritional index (PNI) was used to assess preoperative nutritional status. Donors were divided into 2 groups according to abdominal visceral adipose tissue (VAT) area at the level of the fourth and fifth lumbar vertebrae (<80 or ≥80 cm²). Postoperative renal function was compared in the 2 groups, and prognostic factors for development of chronic kidney disease (CKD) G3b were identified using multivariate analysis.
RESULTS: Donors with a VAT area ≥80 significantly more often had hypertension preoperatively. Although there was no significant difference in preoperative estimated glomerular filtration rate (eGFR) between the 2 groups, postoperative renal function was significantly decreased in donors with a VAT area ≥80 compared to those with a VAT area <80. In multivariate analysis, VAT area ≥80 and PNI <54 were independent factors predicting the development of CKD G3b after 12 months.
CONCLUSIONS: Our findings suggest that preoperative VAT and PNI affect postoperative renal function. Further research is required to establish appropriate exercise protocols and nutritional interventions during follow-up to improve outcomes in living donors.
Keywords: Kidney Function Tests, Kidney Transplantation, Living Donors, Nephrectomy, Nutritional Status
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