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Left‐Sided Living Kidney Donation Leads to Transiently Reduced Adrenocortical Responsiveness
Author(s) -
Burn F.,
Schirpenbach C.,
Bidlingmaier M.,
Reincke M.,
Vetter D.,
Weishaupt D.,
Brockmann J. G.,
Müller M. K.,
Weber M.,
Dahm F.,
Nocito A.
Publication year - 2017
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14184
Subject(s) - medicine , nephrectomy , adrenocorticotropic hormone , urology , plasma renin activity , kidney , stimulation , endocrinology , hormone , surgery , renin–angiotensin system , blood pressure
Living kidney donation is safe and established, but can lead to long‐term complications such as chronic fatigue. Since the adrenal vein is usually transected during left‐sided donor nephrectomy—which is not necessary on the right—we hypothesized that venous congestion might lead to an impairment of adrenal function, offering a possible explanation. In this prospective open label, monocentric cohort study, adrenal function was compared in left‐ and right‐sided living kidney donors. The primary endpoint was plasma cortisol response to low‐dose adrenocorticotropic hormone ( ACTH ) stimulation. Secondary endpoints included plasma renin and ACTH concentration as well as adrenal volume in response to donor nephrectomy. A total of 30 healthy donors—20 left‐ and 10 right‐sided donations—were included. On postoperative day 1, response to low‐dose ACTH stimulation was intact, but significantly lower after left‐sided donor nephrectomy. After 28 days, adrenal responsiveness to ACTH stimulation did not differ any longer. Magnetic resonance imaging volumetry showed no significant adrenal volume change over 4 weeks, neither after left‐ nor after right‐sided nephrectomy. In conclusion, left‐sided living kidney donation entails a transiently reduced adrenocortical responsiveness, which returns to baseline after 28 days.