Elsevier

Transplantation Proceedings

Volume 44, Issue 1, January–February 2012, Pages 276-280
Transplantation Proceedings

Outcome
Long-term outcome
Does Donor Kidney to Recipient Body Weight Ratio Influence Long-Term Outcomes of Living-Donor Kidney Transplantation?

https://doi.org/10.1016/j.transproceed.2011.12.005Get rights and content

Abstract

This study evaluated the effect of the donor kidney to recipient body weight (Kw/Rw) ratio on long-term graft function and survival. We investigated retrospectively whether there was any association between Kw/Rw ratio and long-term graft survival and function after a follow-up of >10 years. We studied a consecutive series of 123 adult-to-adult living kidney transplants. According to the Kw/Rw ratio, patients were divided into 3 groups: “low” (Kw/Rw <2.85; n = 29), “medium” (2.85 ≤ Kw/Rw < 4.04; n = 63), and “high” (≥4.04; n = 31). Among the 3 groups, the mean serum creatinine levels at 1 and 6 months as well as 1 year after transplantation were significantly lower among patients with a high Kw/Rw ratio than in those with a medium or low ratio, but serum creatinine levels at 3 and 5 years did not differ significantly (P = .394 and 0.620, respectively). Graft survival rates at 5 and 10 years after transplantation were significantly lower in the “low” group. We observed a significant association between Kw/Rw ratio and graft survival (P = .018). The Kw/Rw ratio is an important factor for long-term graft survival and early graft function. However, it did not significantly affect subsequent renal function.

Section snippets

Methods

This retrospective cohort study, reviewed the medical records and electronic transplant registry of 261 KT recipients from July 1996 to June 2000. We included only adult-to-adult living renal transplants whose graft survived ≥1 year to diminish the influence of technical failures and immunologic graft losses. We studied a consecutive series of 123 first living-donor kidney transplantations immunosuppressed with a cyclosporine-based regimen. Data on exclusion criteria and number of patients are

Results

Of the 123 kidney transplant recipients, 67.5% were male and 62.6% received a kidney from a male donor. The average recipient age was 37.6 ± 9.7 years. The mean kidney weight was 203 ± 39 g and average recipient body weight was 59.5 ± 10.5 kg. The mean Kw/Rw ratio in our series was 3.52 ± 0.94 (range 1.82–6.80). Patients in the 3 Kw/Rw ratio groups were well matched for recipient age, number of HLA mismatches, and ischemia times. There were significant differences among the 3 groups in the

Discussion

The influence of the functional nephron mass in KT has been analyzed in various ways. However, few reports have referred to the Kw/Rw ratio (a direct measure of graft weight) and long-term graft survival over 10 years. It was the aim of the present study to provide further long-term graft results in relation to the Kw/Rw ratio.

Giral et al2 reported, with a follow-up period of 6.2 years, that a low Kw/Rw ratio was associated with decreased long-term graft survival. Moreover, a Kw/Rw ratio <2.3

References (13)

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Cited by (12)

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    Miller et al.32 showed that if recipients were >30 kg above donors irrespective of DR sex mismatch, there was a HR of 1.5 and 1.35 in male-to-female and female-to-male donations, respectively. Hwang et al.33 reviewed 123 adult LDKTs and found that a low donor kidney to recipient weight ratio (smaller kidney into a recipient with higher BMI) had the lowest 5- and 10-year GS. Several studies31,34 from deceased donor kidney transplant pairs have shown that smaller kidney transplanted into larger recipients resulted in compensatory hyperfiltration, increased creatinine clearance, and higher risks of proteinuria compared with a better-sized match or larger kidneys into smaller recipients.

  • Small kidneys for large recipients: Does size matter in renal transplantation?

    2015, Transplantation Proceedings
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    In our study, however, none of the ratios Kw/Rw, Kv/Rw, or Dw/Rw correlated significantly in uni- or multivariate analysis with the eGFR at 1, 6, 12, 36, and 60 months and there were no differences on the DGF, acute rejection episodes, and estimated graft function at the defined times when comparing the lower Kw/Rw ratio group with the higher one. Hwang et al [22] in an adult-to-adult living-kidney transplantation study concluded that graft survival rates at 5 and 10 years after transplantation were significantly lower in the low ratio group (Kw/Rw ≤ 2.85 g/kg). However, in another study, with 32 months of follow-up, the Kw/Rw ratio had no impact on graft survival [12].

  • Can the kidney weight and recipient body weight ratio predict long-term graft outcome in living donor kidney transplantation?

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    Lee et al5 reported that the volume of living donor kidneys can have a significant and independent impact on the 6 months post-transplantation. In addition to this, Hwang et al10 reported that the Kw/Rw ratio is an important factor for long-term graft survival and early graft function and that it did not significantly affect subsequent renal function. These findings differ from those that claim that the Kw/Rw ratio is an independent predictor of long-term graft survival.3

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