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The effect of kidney size on cadaveric renal allograft outcome
1Department of Medicine, SUNY Health Science Center at Brooklyn, New York 11203, USA.
Abstract:
Chronic rejection is the commonest cause of long-term renal allograft loss. Though immunologic factors are thought dominant in its pathogenesis, nonimmunologic factors, in particular, hyperfiltration damage related to reduced renal mass, have also been proposed as factors in the causation of chronic allograft rejection. We assessed the influence of renal size on graft survival and function in all cyclosporine-treated cadaver donor adult renal allograft recipients engrafted at a single center between June 1989 and July 1994, whose grafts functioned for > or = to 3 months (n=169). Patients were divided into 4 groups based on the ratio of kidney volume to recipient body surface area (volume/BSA) (ml/m2), and outcome in groups compared by methods including Cox's proportional hazards and Kaplan-Meier analysis. No significant differences between groups existed for serum creatinine levels, presence of significant proteinuria, or 1- and 5-year graft survival. There was no correlation between volume/BSA and either serum creatinine or degree of proteinuria at 3, 6, 12, 36, and 60 months posttransplant. Volume/BSA was similar in patients with good or poor renal function (58 +/-21 vs. 56 +/- 28 ml/m2), with or without significant proteinuria (57 +/- 24 vs. 60 +/- 25 ml/m2) or in patients who lost their grafts to chronic rejection compared with those with stable allograft function (64 +/- 34 vs. 59 +/- 24 ml/m2). Volume/BSA was not a predictor of graft survival on multivariate regression. We conclude that donor kidney size has no apparent effect on cadaveric renal allograft outcome in the short and intermediate-term, suggesting that close matching of donor kidney size to recipient size is not presently indicated.
Insights
Donor kidney size does not impact renal allograft survival or function. This study suggests that matching kidney size to recipient size is not critical for cadaveric kidney transplants.
Area of Science:
- Nephrology
- Transplantation Immunology
- Medical Statistics
Background:
- Chronic rejection is the primary cause of long-term renal allograft loss.
- Nonimmunologic factors, such as hyperfiltration injury due to reduced renal mass, are implicated in chronic allograft rejection.
- The role of donor kidney size in renal allograft outcomes requires further investigation.
Purpose of the Study:
- To evaluate the influence of donor kidney size on graft survival and function in adult cadaveric renal allograft recipients.
- To determine if the ratio of kidney volume to recipient body surface area (volume/BSA) predicts renal allograft outcomes.
- To assess the correlation between volume/BSA and graft function markers like serum creatinine and proteinuria.
Main Methods:
- A cohort of 169 cyclosporine-treated cadaver donor adult renal allograft recipients with functioning grafts for at least 3 months were analyzed.
- Patients were stratified into four groups based on kidney volume to recipient body surface area (volume/BSA) ratio.
- Graft survival and function were compared using Kaplan-Meier analysis and Cox's proportional hazards models.
Main Results:
- No significant differences in serum creatinine, proteinuria, or 1- and 5-year graft survival were observed across the volume/BSA groups.
- Volume/BSA showed no correlation with serum creatinine or proteinuria levels at various post-transplant time points.
- Multivariate regression analysis indicated that volume/BSA was not a predictor of graft survival.
Conclusions:
- Donor kidney size does not appear to affect short- and intermediate-term outcomes of cadaveric renal allografts.
- Close matching of donor kidney size to recipient size is not currently indicated for improving renal allograft success.
- Further research may explore long-term effects or specific patient populations where size matching could be relevant.
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