Influence of Donor-Recipient Body Surface Area Ratio on Pediatric Kidney Transplant Outcomes

An adequate organ selection is crucial to minimize perioperative complications and to promote long-term graft survival in kidney transplantation (KT). Therefore, the aim of this study was to evaluate the potential of the donor-recipient body surface area (BSA) ratio as a prognostic factor for transplant outcomes in pediatric recipients.

A total of 88 pediatric patients who underwent KT at our institution between 1995 and 2024 were included in this retrospective analysis. KT recipients were categorized into 3 groups based on donor-recipient BSA-ratio: BSAR-low (≤0.9), BSAR-mid (1.0-1.9), and BSA-high (≥2.0). Clinicopathological characteristics, transplant outcomes, and graft survival were evaluated across the groups.

Recipient age showed a significant inverse correlation with the BSAR (r = -0.750; P < .001). BSAR-high KT were associated with enhanced glomerular filtration rates post-transplant, without significant different graft survival rates in comparison to BSAR-mid KT. Recipients of kidney graft from relatively smaller donors (BSAR-low) showed a trend towards a higher rate of perioperative complications and a significantly higher rate of graft loss compared to BSAR-mid KT (P = .021). Multivariate Cox regression analysis could confirm BSAR-low as an independent risk factor of decreased graft survival (adjusted HR 3.741; P = .008).

Our findings suggest that KTs from relatively larger donors (BSAR-high) are safe and perform comparably to size-matched grafts (BSAR-mid) in pediatric recipients, while smaller donor kidneys (BSAR-low) may carry a higher risk of intraoperative complications and reduced graft survival. Further large-scale studies are needed to validate these observations.