Living kidney donor evaluation and safety assessment

To be able to safely accept potential living kidney donors, more insight is needed in the effect of nephrectomy on a living donor. In this thesis, we aimed to investigate the role of both established and novel glomerular, tubular, and other donor outcome predictors in donor screening and follow-up. We performed renal function measurements in living kidney donor candidates both before and after living kidney donation. We found that estimated Glomerular Filtration Rate (eGFR) can be used in living kidney donation, but that a proportion of living donors will still require measured GFR (mGFR), both in donor screening and in follow-up, to minimize failure of detection of declining renal function. We also demonstrated that the renal functional reserve capacity is a predictor of short-term renal hemodynamics after donation, but not of long-term GFR. Furthermore, we demonstrated that living donor tubular phosphate handling is a predictor of recipient renal function and that post-transplant hypophosphatemia is associated with beneficial outcomes. Finally, we found that pain after nephrectomy is an important donor outcome parameter. These results show that more insight into living kidney donation may lead to better donor outcomes. Therefore, we call for a study involving all aspects of organ donation and transplantation