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Burn, F.; Schirpenbach, C.; Bidlingmaier, M.; Reincke, M.; Vetter, D.; Weishaupt, D.; Brockmann, J. G.; Müller, M. K.; Weber, M.; Dahm, F.; Nocito, A. (2017): Left-Sided Living Kidney Donation Leads to Transiently Reduced Adrenocortical Responsiveness. In: American Journal of Transplantation, Vol. 17, No. 7: pp. 1879-1884
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Abstract

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 end-point 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.