Does size matter? Kidney transplant donor size determines kidney function among living donors

Kidney donor outcomes are gaining attention, particularly as donor eligibility criteria continue to expand. Kidney size, a useful predictor of recipient kidney function, also likely correlates with donor outcomes. Although donor evaluation includes donor kidney size measurements, the association between kidney size and outcomes are poorly defined.

We examined the relationship between kidney size (body surface area-adjusted total volume, cortical volume and length) and renal outcomes (post-operative recovery and longer-term kidney function) among 85 kidney donors using general linear models and time-to-chronic kidney disease data.

Donors with the largest adjusted cortical volume were more likely to achieve an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m² over a median 24-month follow-up than those with smaller cortical volumes (P <0.001), had a shorter duration of renal recovery (1.3-2.2 versus 32.5 days) and started with a higher eGFR at pre-donation (107-110 versus 91 mL/min/1.73 m²) and immediately post-nephrectomy (∼63 versus 50-51 mL/min/1.73 m²). Similar findings were seen with adjusted total volume and length.

Larger kidney donors were more likely to achieve an eGFR ≥60 mL/min/1.73 m² with renal recovery over a shorter duration due to higher pre-donation and initial post-nephrectomy eGFRs.