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Renal mass dosing and graft function in children transplanted from pediatric donors
L de Petris1, Tullio Faraggiana, Gianfranco Rizzoni
1Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital and Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy. lauradepetris@hotmail.com
Insights
Renal mass dosing in pediatric kidney transplants did not impact medium-term graft outcomes. A wide range of graft-to-recipient size ratios showed no significant differences in function or pathology.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Medical Imaging
Background:
- Pediatric kidney graft recipients often receive grafts from donors of varying sizes.
- The concept of "renal mass dosing" suggests that the ratio of kidney volume to recipient body surface area (BSA) may influence graft survival and function.
Purpose of the Study:
- To investigate the impact of varying renal mass dosing on the medium-term evolution of pediatric cadaveric kidney grafts.
- To determine if a wide range of graft volume to recipient BSA ratios affects graft function, pathology, and clinical outcomes.
Main Methods:
- Retrospective analysis of 43 pediatric kidney transplants performed between 1993 and 1999.
- Graft volume calculated using ellipsoid formula from ultrasound within 24 hours post-transplant.
- Patients categorized into three groups based on graft volume to recipient BSA ratio (ml/m²): Group 1 (14-29), Group 2 (30-39), Group 3 (40-110).
- Follow-up included clinical assessment, routine graft biopsies, and evaluation of microalbuminuria, proteinuria, glomerular function, and hypertension incidence.
Main Results:
- No significant differences in absolute renal volume or graft volume increments were observed between the three groups during the first year.
- Routine graft biopsies showed mean glomerular diameters mostly above normal values across all groups, with no significant inter-group differences.
- At an average follow-up of 38 months, no significant differences were found among the groups regarding microalbuminuria, proteinuria, glomerular function, or hypertension incidence.
Conclusions:
- The wide range of renal mass dosing in this cohort of pediatric kidney transplant recipients did not adversely affect medium-term graft evolution.
- Further long-term follow-up is required to fully assess the influence of donor-recipient size disparity on graft outcomes.
Abstract:
It has been suggested that "renal mass dosing" may affect graft evolution. Between 1993 and 1999, 43 children, aged 4-17 years, received 43 pediatric cadaveric grafts. The ratio between graft volume (calculated by ultrasound within the first 24 h from transplantation, by ellipsoid formula) and the recipient's body surface area (BSA) ranged between 14.1 and 110 ml/m(2). Three groups were identified: group 1, 14-29 ml/m(2) (13 patients); group 2, 30-39 ml/m(2) (16 patients); group 3, 40-110 ml/m(2) (14 patients). As a consequence of the different renal volume increments in the three groups during the first year after transplant, no differences in the absolute renal volume were observed at the end of follow-up. The average follow-up was 38 months (range 12-80). In the 37 routine graft biopsies, performed on average 13 months after transplantation and with more than five glomeruli, maximum mean glomerular diameters were mostly above normal values. There were no significant differences among the three groups. At the end of follow-up, the three groups did not differ in microalbuminuria, proteinuria, glomerular function or in incidence of hypertension. From this retrospective study, we conclude that the very wide range of renal mass dosing did not cause differences in medium-term graft evolution. A longer follow-up will be necessary to ascertain the possible influence of disproportion between pediatric donors and recipients, on a long-term graft outcome.