Original article
Long-term safety in living kidney donors for paediatric transplantation. Single-centre prospective study
Seguridad a largo plazo en el donante vivo para trasplante renal pediátrico. Estudio prospectivo, unicéntrico
Javier Martin, Elena Román, Santiago Mendizabal
Corresponding author
Servicio de Nefrología Pediátrica, Hospital La Fe, Valencia, Spain
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Single-centre prospective study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "674" "paginaFinal" => "678" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Javier Martin, Elena Román, Santiago Mendizabal" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Javier" "apellidos" => "Martin" ] 1 => array:2 [ "nombre" => "Elena" "apellidos" => "Román" ] 2 => array:4 [ "nombre" => "Santiago" "apellidos" => "Mendizabal" "email" => array:1 [ 0 => "mendizabal_san@gva.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Nefrología Pediátrica, Hospital La Fe, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seguridad a largo plazo en el donante vivo para trasplante renal pediátrico. Estudio prospectivo, unicéntrico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1754 "Ancho" => 1658 "Tamanyo" => 163957 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Live donor kidney transplants under study.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Living donor kidney transplantation (LDKT) is the treatment of choice for children with advanced chronic kidney disease. It reduces the waiting time for transplant, the morbidity/mortality, and it improves the survival for both the graft and the recipient.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">1,2</span></a> The use of LDKT has increased in recent years for various reasons. There is an increased in the prevalence of advanced chronic kidney disease<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a> and there is decrease in the number of suitable brain-dead donors (a factor that especially affects children awaiting for a transplant),<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> and in addition the procedure for donors<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> has been improved in safety and short-term risks of the intervention have been minimised with the use of laparoscopic surgery. Nevertheless, since the main objective of LDKT is to ensure the safety of the donor, the scientific community has recently become interested in the possible long-term complications of donors.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Retrospective cohort studies with short follow-up suggest that a donors survival is similar to the general population, or even longer.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> Recently, however, long follow up studies have been published with populations that are especially healthy compared to the population of kidney donors, and these studies point to an increased incidence of chronic kidney disease and long-term mortality.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7–13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore the long-term risk of complications is an area of special interest for transplants in the paediatric population, because the donors are usually their parents which are usually young<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> that should have a long survival. These donors may be exposed to the complications derived from having only one kidney.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this study is to assess the long-term consequences of nephrectomies in our donor population for LDKT in our Paediatric Nephrology Department. To this end, we have analysed the evolution of the patients (donors), glomerular filtration (GF), blood pressure (BP), incidence of hypertension (HT) and the existence of periodic proteinuria or microalbuminuria as markers of kidney pathology.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We present a single-centre prospective cohort study. From the time our paediatric kidney transplant department opened in April 1979 to June 2014, our department has performed 390 transplants, 54 of them were from living donors. All donors were relatives: 30 mothers, 22 fathers, one sibling and one aunt.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Of the total group of 54 donors, 6 were excluded because they had a follow-up period of less than one year when the study closed in June 2014. Thus, the initial group included 48 donors with a minimum one-year follow-up period. The average age of the donors was 38 (18–51), and the average follow-up period was 12.5 years (1–30). Of these 48 donors, we evaluated the evolution and final status of 9 of them using a telephone and/or personal survey because they do not live in our area. We verified their evolution and clinical status at the end of the study using their clinical records and an assessment of their blood chemistries, to rule out kidney pathologies and to define kidney function. Nevertheless, we did not include these patients in the final statistical analysis because clinical examinations and tests were not conducted by ourselves. Therefore, our analysis focuses on the other 39 donors (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Informed consent was obtained from all of donors, and the study was approved by our hospital's ethics committee.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Both the pre-nephrectomy study of the donors to assess their clinical status, and the subsequent follow-up study were performed in our Paediatric Nephrology Department. The preliminary study excluded donors presenting systemic, psychological or kidney pathologies that contraindicated donation, and this was confirmed by the Internal Medicine Department in accordance with the recommended guidelines for being kidney donors.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> Up to the present time, 40% of the possible donors have been ruled out for medical and/or psychological reasons due to the strict evaluation of requirements needed to qualify as donor.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A post-donation follow-up protocol is followed that includes periodic visits for medical interviews, blood tests to assess kidney and systemic pathologies such as dyslipidemia, diabetes and obesity that can negatively affect kidney evolution. We also monitor the donors’ BP, calculate their GFR l and investigate the presence of proteinuria. The frequency of these examinations is quarterly during the first year and annual or bi-annual thereafter, coinciding with the clinical visits of the recipients.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patients’ BP was measured 3 consecutive times at rest in the hospital's outpatient clinic and by out patient monitoring. We define hypertension (HTN) as a systolic BP of 140<span class="elsevierStyleHsp" style=""></span>mmHg or higher, a diastolic BP of 90<span class="elsevierStyleHsp" style=""></span>mmHg or and/or treatment with anti-hypertensive drugs.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The patients’ GFR are estimated by calculating the creatinine clearance rate (CCr) using their 24-h urine adjusted for their body surface area (mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>). Proteinuria is tested in 24-h urine and it is defined as >300<span class="elsevierStyleHsp" style=""></span>mg/day, with urinary proteinuria between 30 and 300<span class="elsevierStyleHsp" style=""></span>mg/day classified as microalbuminuria.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The results are presented as median<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation and/or range. The statistical significance of non-parameter data was analysed using a Student's <span class="elsevierStyleItalic">t</span>-test. The cumulative incidence is expressed as a percentage (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Findings (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>)</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Glomerular filtration and onset of chronic kidney disease</span><p id="par0065" class="elsevierStylePara elsevierViewall">The most stable parameter over time was CCr. The mean pre-transplantation was 128<span class="elsevierStyleHsp" style=""></span>mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>. After an initial decrease from the pre-nephrectomy level, the GF level stabilised one year after the transplant at 100<span class="elsevierStyleHsp" style=""></span>mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>, and this value was maintained during 15 years of the follow-up period (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). A CCr below 60<span class="elsevierStyleHsp" style=""></span>mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> was not observed in any case. Proteinuria, defined as albuminuria >300<span class="elsevierStyleHsp" style=""></span>mg/day, was not detected in any of the donors.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">One case of advanced kidney disease was recorded after telephone interview and later on in person. This donor refused follow up and 18 years after the nephrectomy he was diagnosed with HTN, proteinuria and dyslipidaemia in an outpatient examination. He refused treatment and subsequent follow-up. The patient presented with progressive renal insufficiency with a need for dialysis 28 years after the nephrectomy, having received a kidney transplant at age 60 (33 years post-nephrectomy). The recipient (his son) currently has normal function of his transplant 33 years after the transplantation, with creatinine below 1<span class="elsevierStyleHsp" style=""></span>mg/dl, with an underlying condition of renal dysplasia with malformed uropathy.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Hypertension</span><p id="par0075" class="elsevierStylePara elsevierViewall">The average pre-donation systolic blood pressure was 118<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>19<span class="elsevierStyleHsp" style=""></span>mmHg and the average diastolic blood pressure was 74<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>mmHg. The donors’ BP increased over the follow-up period with an HT diagnosis criterion in 10 of the 39 donors studied (25%) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), 90% of whom were prescribed treatment with anti-hypertension medication.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Our analysis revealed stability of GFR in our study population of 15 years of follow-up, after an immediate initial decrease attributed to loss of renal parenchyma, as normally observed in other series.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> We observed a progression to advanced renal disease in one of the 48 donors (2.01%.) The patient refused follow-up and treatment with a need for replacement kidney therapy 28 years post-nephrectomy. None of the other patients had a GFR below 60<span class="elsevierStyleHsp" style=""></span>mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>, with a prevalence of stage 3–4 CKD of less than the 3.3% described for the general population with similar characteristics.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The development of advanced renal failure in one case – with no underlying conditions related to the recipient's TKD, and which is supposedly related to the harm induced by the patient's hypertension, dyslipidaemia and obesity that was noted in his clinical history – substantiates and confirms the need to closely monitor donors post-nephrectomy, as this may prevent the progression to terminal renal failure.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Numerous previous studies, mostly in the United States population, have evaluated renal function, describing terminal renal failure prevalences of 0.15–0.87%, and CKD prevalences of 5.2–14.5%.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7,9,15,17–19</span></a> A large majority of these studies are based on retrospective cohorts taken from state transplant records, with short evolution periods and compared to the general population that is taken as a control group. Nevertheless, since the donor community is a particularly healthy group, recent findings have been added from studies that used control groups from a specially selected population that is more comparable with the health characteristics of a donor population.<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">20–22</span></a> Mjoen et al. found a 0.31% cumulative incidence of CKD in a prospective cohort of 1901 Norwegian donors with a long follow-up period of 15 years and a hazard ratio of 11.4 vs. an control population that was particularly healthy. Likewise, Muzaale et al. observed a cumulative CKD incidence of 0.31% in live donors compared to 0.03% in a healthy control group.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The cumulative incidence of HT in our study was 25%: which is inferior to values in the general population with the same age range reported by Banegas in a cross-sectional study of the Spanish population.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a> With active follow-up, all our patients were aware of their hypertension, and 90% of the hypertensive patients were treated with anti-hypertension medication. Studies of kidney donors also describe comparable HT prevalences among the general population.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">15,17</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The transplant community has expressed its concern about the long-term complications that might arise from kidney transplants. In recent years, concern has been particularly focused on young donors.<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">24,25</span></a> These donors have a longer exposure to a reduction of renal parenchyma, and to the complications this may entail. Moreover, since they have a high survival rate, they also have a higher risk of onset of medical pathologies that may lead to subsequent kidney disease. In this regard, in 2008 Gibney et al. described a higher risk of terminal renal failure in their donors under the age of 35.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a> The average age of our paediatric donors is 38, so they are 13 years younger than the donors for adult patients.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> They are therefore a cohort that is of great interest for studying long-term kidney complications in this population.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Although our study does present a small number of donors compared to the series published for transplantations in adults, its long follow up and its prospective character make it especially interesting for assessing the risk of HT and/or the onset of CKD. As a single-centre study, both the pre- and post-nephrectomy studies were conducted in our Paediatric Nephrology Department, which made collecting and compiling the study's clinical and analytical data uniform and homogeneous. Thus, 9 of the donors whom we did not examine directly were ruled out, instead merely assessing their final status with regard to their clinical situation.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In conclusion, our findings show that the incidence of CKD, HT and renal function burden in donors may be similar to the general population, and that kidney donation for paediatric kidney disease patients is reasonably safe if it is associated with strict controls prior to the nephrectomy and thereafter that would make it possible to diagnose, control and early treatment for any possible complications. Long follow up studies will be necessary to evaluate a higher survival rate in paediatric vs. adult donors.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that there are no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres803823" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec802012" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres803824" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec802013" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Findings (Table 1)" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Glomerular filtration and onset of chronic kidney disease" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Hypertension" ] ] ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-12-10" "fechaAceptado" => "2016-03-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec802012" "palabras" => array:5 [ 0 => "Kidney transplantation" 1 => "Living kidney donor" 2 => "Arterial hypertension" 3 => "Advanced chronic kidney disease" 4 => "Paediatric transplantation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec802013" "palabras" => array:5 [ 0 => "Trasplante renal" 1 => "Donante renal vivo" 2 => "Hipertensión arterial" 3 => "Enfermedad renal crónica avanzada" 4 => "Trasplante infantil" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">There is enough evidence concerning the short-term safety of living donors after kidney transplantation. However, long-term complications continue to be studied, with a particular interest in young donors. Previous studies have been conducted in older donors for adult renal patients. We present a study of long-term complications in kidney donors for our paediatric population.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We carried out a long-term donor study for the 54 living kidney-donor transplantations performed at our department from 1979 to June 2014. We monitored the glomerular filtration rate (GFR) on the basis of 24-h urine creatinine clearance, 24-h proteinuria and the development of arterial hypertension in the 48 donors who were followed up for more than one year. Only the 39 patients who were exclusively followed up by our department have been included in the results analysis.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">GFR through creatinine clearance was stable after an initial decrease. No proteinuria was observed in any of the cases. One patient developed chronic kidney disease (CKD), which resulted in a cumulative incidence of 2%. GFR below 60<span class="elsevierStyleHsp" style=""></span>mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> was not reported in any other patients. Arterial hypertension was diagnosed in 25% of donors, 90% of which were treated with antihypertensives.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Risk of CKD and hypertension in living kidney donors for paediatric recipients, who are carefully monitored throughout their evolution, is similar to that of the general population. Therefore, this technique appears to be safe in both the short and long term.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Existe evidencia suficiente sobre la seguridad a corto plazo en el donante vivo tras el trasplante renal. Sin embargo, las complicaciones a largo plazo continúan siendo un área de estudio en la actualidad, de especial interés en el donante joven. Previamente se han realizado análisis en donantes de edad más avanzada para enfermos renales adultos. Presentamos un estudio de complicaciones a largo plazo en donantes renales para nuestra población pediátrica.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudiamos a largo plazo a los donantes de los 54 trasplantes renales de donante vivo realizados en nuestro servicio desde 1979 hasta junio del 2014. Hemos monitorizado el filtrado glomerular (FG) mediante aclaramiento de creatinina en orina de 24<span class="elsevierStyleHsp" style=""></span>h, proteinuria en orina de 24<span class="elsevierStyleHsp" style=""></span>h y el desarrollo de hipertensión arterial (HTA) en los 48 donantes que han presentado un seguimiento mayor de un año. En el análisis de resultados se han incluido tan solo a los 39 pacientes que han sido exclusivamente controlados en nuestro servicio.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El FG mediante aclaramiento de creatinina fue estable tras su descenso inicial. No se observó proteinuria en ninguno de los casos. Se observó enfermedad renal crónica (ERC) avanzada en un paciente, lo cual supuso una incidencia acumulada del 2%, no describiéndose FG menor de 60<span class="elsevierStyleHsp" style=""></span>mL/min/1,73m<span class="elsevierStyleSup">2</span> en ningún otro paciente. La HTA fue diagnosticada en el 25% de los donantes, con tratamiento hipotensor en el 90% de ellos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El riesgo de ERC y de HTA en donantes renales vivos para receptor pediátrico cuidadosamente monitorizados en su evolución es similar al de la población general por lo que parece tratarse de una técnica segura a corto y largo plazo.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martin J, Román E, Mendizabal S. Seguridad a largo plazo en el donante vivo para trasplante renal pediátrico. Estudio prospectivo, unicéntrico. Nefrología. 2016;36:674–678.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1754 "Ancho" => 1658 "Tamanyo" => 163957 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Live donor kidney transplants under study.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1136 "Ancho" => 1652 "Tamanyo" => 81331 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Glomerular filtration evolution as estimated by creatinine clearance in 24-h urine in the live donor for LDKT. <span class="elsevierStyleItalic">n</span>, sample size.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1613 "Ancho" => 1658 "Tamanyo" => 82188 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Changes in blood pressure (mmHg) in live donors for LDKT. <span class="elsevierStyleItalic">n</span>, sample size; DBP, diastolic blood pressure; SBP, systolic blood pressure.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The sample set comprises 39 donors with full data collected in our health centre.</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CCr, creatinine clearance; GF, glomerular filtration; <span class="elsevierStyleItalic">n</span>, sample; DBP, diastolic blood pressure; SBP, systolic blood pressure; LDKT, live donor kidney transplant.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LDKT donors (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>39) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Average age (max-min) (years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 (18–51) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Male/female (n)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22/17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Relatives (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Average follow-up period (min-max) (years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.5 (1–30) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">GF (CCr) (ml/min/1.73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Before 1 year -5 years -10 years -15 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">128-101-100-98-110 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Serum Cr (mg/dL)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Before 1 year -5 years -10 years -15 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.86-1.06-1.03-1.03-1.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">SBP/DBP (mmHg)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Before 1 year -5 years -10 years -15 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">111/70-116/73-118/74-126/80 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Microalbuminuria (μg/min)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Before 1 year -5 years -10 years -15 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.1-8.2-19.7-35.4-35.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1349416.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Findings.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High survival rates of kidney transplants from spousal and living unrelated donors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.I. Tersaki" 1 => "J.M. Cecka" 2 => "D.W. Gjertson" 3 => "S. Takemoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199508103330601" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1995" "volumen" => "333" "paginaInicial" => "333" "paginaFinal" => "336" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7609748" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0135" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "OPTN/SRTR 2012. Annual data report: kidney" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.J. Matas" 1 => "J.M. Smith" 2 => "M.A. Skeans" 3 => "B. Thompson" 4 => "S.K. 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| Year/Month | Html | Total | |
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| 2024 November | 3 | 4 | 7 |
| 2024 October | 44 | 36 | 80 |
| 2024 September | 39 | 27 | 66 |
| 2024 August | 67 | 69 | 136 |
| 2024 July | 30 | 24 | 54 |
| 2024 June | 51 | 33 | 84 |
| 2024 May | 64 | 39 | 103 |
| 2024 April | 52 | 39 | 91 |
| 2024 March | 41 | 24 | 65 |
| 2024 February | 36 | 35 | 71 |
| 2024 January | 30 | 25 | 55 |
| 2023 December | 23 | 23 | 46 |
| 2023 November | 35 | 27 | 62 |
| 2023 October | 37 | 26 | 63 |
| 2023 September | 32 | 33 | 65 |
| 2023 August | 30 | 10 | 40 |
| 2023 July | 34 | 25 | 59 |
| 2023 June | 28 | 16 | 44 |
| 2023 May | 47 | 24 | 71 |
| 2023 April | 25 | 12 | 37 |
| 2023 March | 56 | 20 | 76 |
| 2023 February | 44 | 19 | 63 |
| 2023 January | 31 | 24 | 55 |
| 2022 December | 65 | 31 | 96 |
| 2022 November | 60 | 24 | 84 |
| 2022 October | 74 | 38 | 112 |
| 2022 September | 64 | 23 | 87 |
| 2022 August | 49 | 46 | 95 |
| 2022 July | 33 | 43 | 76 |
| 2022 June | 39 | 28 | 67 |
| 2022 May | 34 | 30 | 64 |
| 2022 April | 55 | 42 | 97 |
| 2022 March | 50 | 47 | 97 |
| 2022 February | 34 | 35 | 69 |
| 2022 January | 31 | 38 | 69 |
| 2021 December | 50 | 34 | 84 |
| 2021 November | 39 | 24 | 63 |
| 2021 October | 33 | 64 | 97 |
| 2021 September | 32 | 30 | 62 |
| 2021 August | 24 | 38 | 62 |
| 2021 July | 29 | 25 | 54 |
| 2021 June | 21 | 32 | 53 |
| 2021 May | 31 | 44 | 75 |
| 2021 April | 106 | 74 | 180 |
| 2021 March | 45 | 39 | 84 |
| 2021 February | 49 | 41 | 90 |
| 2021 January | 55 | 16 | 71 |
| 2020 December | 40 | 14 | 54 |
| 2020 November | 40 | 22 | 62 |
| 2020 October | 28 | 12 | 40 |
| 2020 September | 35 | 28 | 63 |
| 2020 August | 49 | 23 | 72 |
| 2020 July | 39 | 17 | 56 |
| 2020 June | 32 | 16 | 48 |
| 2020 May | 47 | 16 | 63 |
| 2020 April | 33 | 21 | 54 |
| 2020 March | 36 | 18 | 54 |
| 2020 February | 33 | 17 | 50 |
| 2020 January | 36 | 29 | 65 |
| 2019 December | 50 | 33 | 83 |
| 2019 November | 32 | 18 | 50 |
| 2019 October | 19 | 13 | 32 |
| 2019 September | 26 | 15 | 41 |
| 2019 August | 21 | 20 | 41 |
| 2019 July | 21 | 21 | 42 |
| 2019 June | 27 | 35 | 62 |
| 2019 May | 26 | 36 | 62 |
| 2019 April | 44 | 38 | 82 |
| 2019 March | 50 | 21 | 71 |
| 2019 February | 27 | 19 | 46 |
| 2019 January | 36 | 27 | 63 |
| 2018 December | 202 | 44 | 246 |
| 2018 November | 319 | 20 | 339 |
| 2018 October | 379 | 24 | 403 |
| 2018 September | 171 | 27 | 198 |
| 2018 August | 90 | 82 | 172 |
| 2018 July | 60 | 19 | 79 |
| 2018 June | 62 | 19 | 81 |
| 2018 May | 128 | 17 | 145 |
| 2018 April | 137 | 12 | 149 |
| 2018 March | 136 | 11 | 147 |
| 2018 February | 147 | 10 | 157 |
| 2018 January | 151 | 15 | 166 |
| 2017 December | 114 | 8 | 122 |
| 2017 November | 73 | 12 | 85 |
| 2017 October | 41 | 12 | 53 |
| 2017 September | 70 | 12 | 82 |
| 2017 August | 72 | 6 | 78 |
| 2017 July | 102 | 17 | 119 |
| 2017 June | 87 | 8 | 95 |
| 2017 May | 98 | 11 | 109 |
| 2017 April | 83 | 12 | 95 |
| 2017 March | 73 | 6 | 79 |
| 2017 February | 40 | 5 | 45 |
| 2017 January | 56 | 12 | 68 |
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