Impact of Graft Kidney Volume and Weight on Graft Function in Living Donor Kidney Transplantation / 대한이식학회지

BACKGROUND: Low functional nephron mass and graft kidney-recipient body size mismatch can lead to poor graft function. To examine the impact of the ratios of the surrogates to recipient body surface area (BSA) and body weight on graft function within 5 years post-transplantation, we measured the graft kidney volume, using computed tomography with 3-dimensional reconstruction before transplantation, and measured the graft kidney weight during surgery in living donor kidney transplantation (LDKT). METHODS: Between February 2004 and November 2013, 142 LDKT recipients without delayed graft function, acute rejection, or infection within 5 years of transplantation were included. The graft function and its relations with graft kidney volume and its weight were analyzed. RESULTS: The graft kidney volume/recipient BSA ratio showed correlation with the estimated glomerular filtration rate (eGFR) of recipients after 3 years post-transplantation. We found a difference in the graft function between recipients with a graft kidney volume/recipient BSA ratio of > or =80.4 mL/m2 and those with a ratio of <80.4 mL/m2 (P<0.05). Multivariate analysis showed that the graft kidney volume/recipient BSA ratio, the graft kidney weight/recipient body weight ratio, donor age, donor eGFR, and donor/recipient BSA ratio are independent predictors of graft function at each period of transplantation (P<0.05). CONCLUSIONS: The graft kidney volume of living donors may predict graft function and during living donor and recipient matching, both the potential volume of the donated kidney and the body size of the recipient should be considered.

Metabolic Demand and Nephron Supply on Early Graft Function after Living Donor Kidney Transplantation / 대한이식학회지

PURPOSE: Renal allograft mass may potentially affect long term outcome after kidney transplantation. An inadequate renal mass to metabolic demand might trigger hyperfiltration and consequently contribute to the progression of graft nephropathy and failure. METHODS: This is a prospective study with 195 cases of 2 transplant centers. The study population was restricted to live donor transplants except the cases of diabetes, ischemic injury, rejection, and any complication which might result in functional decrease of the kidney graft. Recipient's serum creatinine, 24 hours proteinuria, urine creatinine excretion and creatinine clearance were measured and calculated. Weight of donated kidney, weights and heights of both donors and recipients were recorded and the BSA, LBW, and BMI were calculated. The correlations between each variables were analyzed using Pearson's test, and P<.05 was considered significant. Significantly correlated pairs of variables were included into the linear regression for multivariate test. RESULTS: The amount of urinary excretion of protein is associated with renal mass supply rather than functional demand of recipient. The serum creatinine is associated with the functional balance between the metabolic demand of recipient and renal mass supply from donor. The amount of urinary excretion of creatinine is associated with metabolic demand of recipient rather than renal mass supply. CONCLUSION: Our findings provide direct evidence of a substantial effect of the balance between nephron supply and recipient metabolic demand on early graft function. We suggest that during donor-recipient matching, both the potential sizes of donated kidney and recipient should be considered in terms of early graft function.