{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:37:32Z","timestamp":1792802252478,"version":"4.5.0"},"reference-count":31,"publisher":"PAGEPress Publications","issue":"2","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Background: Most living kidney donors recover 60-70% of baseline renal function, yet some show suboptimal compensation despite a favorable baseline eGFr. The remnant kidney volume to weight ratio (rKV\/w) reflects anatomical reserve relative to metabolic demand, but its predictive value has not been tested in Middle eastern populations, and it is unknown whether volumetric hypertrophy guarantees functional gain.\nMethods: we retrospectively analyzed 368 living kidney donors who underwent left sided laparoendoscopic single site nephrectomy (2017-2024). Preoperative CT volumetry measured rKV\/w. suboptimal recovery was defined as eGFr &lt; 60% of baseline at 1 year. Multivariate logistic regression, roC analysis, and a point score were developed. In 124 donors with follow up imaging, we compared compensatory hypertrophy (percent volume increase) between recovery groups.\nResults: suboptimal recovery occurred in 38 donors (10.3%). rKV\/w independently predicted suboptimal recovery (adjusted or 2.94; 95% CI 1.85-4.67; p &lt; 0.001). A threshold of 2.2 mL\/kg yielded 84.2% sensitivity and 76.1% specificity (AUC for rKV\/w alone 0.82). rKV\/w correlated modestly with MAG3 split function (rho = 0.31; 95% CI 0.20-0.41). A 4 item point score (age \u2265 35, BMI \u2265 27, baseline eGFr \u2265 95, rKV\/w &lt; 2.2) achieved an AUC of 0.84. Novel finding: compensatory hypertrophy was similar between groups (18.2% vs 19.5% volume increase, p = 0.52), yet functional recovery differed significantly, a \u201chypertrophy paradox.\u201d\nConclusions: rKV\/w independently predicts post donation functional compensation, supporting a structure-demand model. The hypertrophy paradox challenges the assumption that an increase in volume alone equates to adaptation. The 2.2 mL\/kg threshold and point score (AUC 0.84) offer practical risk stratification tools, but external validation is required before clinical use.<\/jats:p>","DOI":"10.4081\/aiua.2026.15640","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T09:00:22Z","timestamp":1780650022000},"source":"Crossref","is-referenced-by-count":0,"title":["Remnant kidney volume-to-weight ratio and point score predict post-donor kidney function: the hypertrophy paradox and structure-demand model"],"prefix":"10.4081","volume":"98","author":[{"given":"Hany M.","family":"El Hennawy","sequence":"first","affiliation":[{"name":"Surgery Department, Section of Transplantation, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Safar","sequence":"additional","affiliation":[{"name":"Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Tawhari","sequence":"additional","affiliation":[{"name":"Internal Medicine, King Khalid University College of Medicine, Abha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha Jaber","family":"Asiri","sequence":"additional","affiliation":[{"name":"Surgery Department, Section of Transplantation, Ministry of National Guard and Health Affairs, Riyadh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Thamer","family":"Alshahrani","sequence":"additional","affiliation":[{"name":"Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahad Shari","family":"Alshahrani","sequence":"additional","affiliation":[{"name":"Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Hassan","family":"Alobaid","sequence":"additional","affiliation":[{"name":"Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Laghbi","sequence":"additional","affiliation":[{"name":"Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghaleb A.","family":"Aboalsamh","sequence":"additional","affiliation":[{"name":"Surgery Department, Section of Transplantation, King Faisal Specialist Hospital and Research Center, Jeddah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tariq","family":"Jaber","sequence":"additional","affiliation":[{"name":"Department of Surgery, National Guard Hospital, Jeddah; King Saud bin Abdulaziz University for Health Sciences, Jeddah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menna","family":"El Hennawy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Mansoura University, Mansoura"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Khedr","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, New Mansoura University, New Mansoura"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Jordan, Amman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed F.","family":"Bazeed","sequence":"additional","affiliation":[{"name":"Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia; Radiology Department, Faculty of Medicine, Mansoura University, Mansoura"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"233663","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2016.02.047"},{"key":"233664","doi-asserted-by":"publisher","DOI":"10.6002\/ect.MESOT2021.O35"},{"key":"233665","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMe1513891"},{"key":"233666","doi-asserted-by":"publisher","DOI":"10.7150\/ijms.17585"},{"key":"233667","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14671"},{"key":"233668","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14678"},{"key":"233669","doi-asserted-by":"publisher","DOI":"10.1016\/0272-6386(95)90664-9"},{"key":"233670","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-019-1588-3"},{"key":"233671","doi-asserted-by":"publisher","DOI":"10.1172\/JCI80818"},{"key":"233672","doi-asserted-by":"publisher","DOI":"10.5500\/wjt.v12.i8.223"},{"key":"233673","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12369"},{"key":"233674","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2006.01359.x"},{"key":"233675","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2010.04.079"},{"key":"233676","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-019-1242-0"},{"key":"233677","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13683"},{"key":"233678","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-019-1464-1"},{"key":"233679","doi-asserted-by":"publisher","DOI":"10.23736\/S2724-6051.24.05556-3"},{"key":"233680","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-016-0168-0"},{"key":"233681","doi-asserted-by":"publisher","DOI":"10.1016\/j.kjms.2016.01.003"},{"key":"233682","unstructured":"20. 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