title: Left-Sided Living Kidney Donation Leads to Transiently Reduced Adrenocortical Responsiveness.
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 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.
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Burn
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, University Hospital Munich, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schirpenbach
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, University Hospital Munich, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Bidlingmaier
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, University Hospital Munich, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Reincke
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Vetter
authors.affiliation: Department of Radiology and Nuclear Medicine, Triemli Hospital Zurich, Zurich, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Weishaupt
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: J G
authors.initials: JG
authors.lastname: Brockmann
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.|Department of Surgery, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: M K
authors.initials: MK
authors.lastname: Müller
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.|Department of Surgery, Triemli Hospital Zurich, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Weber
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Dahm
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.|Department of Surgery, Cantonal Hospital Baden, Baden, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Nocito
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006728:Hormones / Q000494:pharmacology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007668:Kidney / Q000187:drug effects / Q000378:metabolism* / Q000473:pathology; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011379:Prognosis; D011446:Prospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*
chemical_list: D006728:Hormones; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone
keywords: clinical research/practice; kidney transplantation/nephrology; kidney transplantation: living donor; surgical technique