Post-Nephrectomy Renal Outcomes in Living Kidney Donors with Diabetes and Prediabetes: A Retrospective Cohort Study
Saifu Yin, Yan Zhou, Wenxia Huang, Xia Huang, Yun Luo, Xing Li, Lijuan Wu, Turun Song, Tao LinAbstract
Background
Kidney transplantation is the optimal treatment for end-stage renal disease (ESRD), but the persistent donor shortage necessitates expanding the donor pool, including utilizing living donors with dysglycemia. However, their post-nephrectomy safety remains inadequately characterized.
Methods
This retrospective cohort study analyzed 771 living donors (699 normal, 53 impaired fasting glucose [IFG], 19 diabetes) undergoing nephrectomy (2017-2023). The primary outcome was acute eGFR slope. Multivariable linear regression identified independent risk factors. A targeted systematic review with meta-analysis was conducted to summarize existing evidence.
Results
Over a median 31-month follow-up, no donors developed ESRD. Diabetic donors had a higher incidence of eGFR <45 ml/min/1.73 m2 (10.5% vs. 1.9% vs. 1.4%, P=0.041). The acute eGFR slope was steeper in diabetic donors (-17.3 vs. -14.4 vs. -13.2 ml/min/1.73m2/year, P=0.038). Multivariable analyses identified diabetes (β=-3.85, 95%CI: -7.24--0.47, P=0.026), hypertension, microalbuminuria, and higher body mass index as independent risk factors. An exploratory subgroup analysis showed that IFG donors with baseline eGFR <90 mL/min/1.73m2 had a steeper eGFR slope compared to those with eGFR ≥90 ml/min/1.73m2 (P=0.004). Additional meta-analyses suggested that donors with dysglycemia may have worse renal function (P=0.036) and a higher incidence of hypertension (P=0.031) with high heterogeneity.
Conclusion
Pre-donation diabetes may increase post-nephrectomy renal risk, while IFG alone may be safe unless accompanied by reduced baseline eGFR. Notably, these hypothesis-generating findings are limited by the small sample size of the diabetic and IFG groups, and relatively short follow-up. Large multicenter cohorts with decades-long follow-up are still required.