Journal List > J Korean Soc Transplant > v.29(4) > 1034468

Seong, Su, Je, and Oh: Impact of Graft Kidney Volume and Weight on Graft Function in Living Donor Kidney Transplantation

Abstract

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 ≥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.

References

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Table 1.
Overall characteristics of donors, recipients, and graft kidney
Demographic Value
Donor and graft characteristics  
  Age (yr) 38.6±11.0
  Sex (male:female) 74:68
  Height (cm) 165.7±8.9
  Weight (kg) 66.2±11.9
  BSA (m2) 1.74±0.19
  G-KW (g) 195.4±39.3
  G-KV (mL) 140.3±20.4
  D-BKV (mL) 281.3±40.2
Recipient characteristics  
  Age (yr) 42.3±10.4
  Sex (male:female) 87:55
  Height (cm) 165.6±8.4
  Weight (kg) 62.4±11.8
  BSA (m2) 1.69±0.19
D-BSA/R-BSA 1.0±0.2
Ratio indices of graft to recipient body mass  
  G-KV/R-BSA (mL/m2) 84.0±14.8
  G-KW/R-BW (g/kg) 3.2±0.8
Transplant-related information  
  Donor type 100:42
    (living related/living unrelated)  
  Immunosuppression  
    Double:triple 4 (2.8):138 (97.2)
    Basiliximab 133 (93.7)
  Degree of HLA match  
    0 Ag match 11 (7.7)
    1 Ag match 20 (14.1)
    2 Ag match 22 (15.5)
  Haploidentical 73 (51.4)
  Identical 16 (11.3)

Data are presented as mean±SD or number (%).

Abbreviations: BSA, body surface area; G-KW, graft kidney weight; G-KV, graft kidney volume; D-BKV, donor bilateral kidney volume; D-BSA/R-BSA, ratio of donor body surface area to recipient body surface area; G-KV/R-BSA, ratio of graft kidney volume to recipient body surface area; G-KW/R-BW, ratio of graft kidney weight to recipient body weight; HLA, human leukocyte antigen. 

Table 2.
Correlation between the ratio indices of graft and post-transplant graft function
Variable G-KV/R-BSA G-KW/R-BW  
Correlation coefficient (r) P-value Correlation coefficient (r) P-value
eGFR (mL/min/1.73 m2)        
  1 month 0.476 <0.001 0.339 <0.001
  3 months 0.443 <0.001 0.309 <0.001
  6 months 0.437 <0.001 0.302 <0.001
  1 year 0.340 <0.001 0.196 0.021
  3 years 0.224 <0.001 0.131 0.175
  5 years 0.195 0.117 0.053 0.674

Abbreviations: G-KV/R-BSA, ratio of graft kidney volume to recipient body surface area; G-KW/R-BW, ratio of graft kidney weight to recipient body weight; eGFR, estimated glomerular filtration rate.

Table 3.
Effects of ratio indices of graft on post-transplant graft function
Variable G-KV/R-BSA (mL/m2) G-KW/R-BW (g/kg)
<84.0 ≥84.0 P-value <3.2 ≥3.2 P-value
sCr (mg/dL)            
  1 month 1.43±0.31 1.17±0.40 <0.001 1.41±0.30 1.17±0.43 <0.001
  3 months 1.43±0.31 1.16±0.27 <0.001 1.42±0.29 1.15±0.29 <0.001
  6 months 1.44±0.31 1.17±0.24 <0.001 1.43±0.29 1.16±0.26 <0.001
  1 year 1.43±0.31 1.20±0.24 <0.001 1.44±0.30 1.17±0.23 <0.001
  3 years 1.49±0.30 1.31±0.43 0.017 1.51±0.38 1.25±0.33 <0.001
  5 years 1.58±0.45 1.52±1.13 0.793 1.54±0.43 1.55±1.32 0.959
eGFR (mL/min/1.73 m2)            
  1 month 53.5±11.2 63.4±15.0 <0.001 55.2±11.6 62.3±15.7 0.003
  3 months 53.1±9.9 62.2±14.0 <0.001 54.2±10.9 61.6±14.5 0.001
  6 months 52.4±10.0 61.4±12.7 <0.001 54.1±10.9 60.2±13.0 0.003
  1 year 52.7±10.5 59.5±13.0 0.001 53.5±11.5 59.0±12.5 0.008
  3 years 51.3±9.9 56.4±15.7 0.048 51.8±13.3 56.7±13.3 0.050
  5 years 48.6±13.0 55.5±19.2 0.098 50.3±13.7 55.4±20.9 0.233

Data are presented as mean±SD.

Abbreviations: G-KV/R-BSA, ratio of graft kidney volume to recipient body surface area; G-KW/R-BW, ratio of graft kidney weight to recipient body weight; sCr, serum creatinine; eGFR, estimated glomerular filtration rate.

Table 4.
The ratio indices of graft affecting to post-transplant graft function: univariate linear regression analysis
Variable G-KV/R-BSA G-KW/R-BW
β P-value β P-value
eGFR (mL/min/1.73 m2)        
  1 month 0.452 <0.001 5.547 <0.001
  3 months 0.386 <0.001 4.636 <0.001
  6 months 0.360 <0.001 4.289 <0.001
  1 year 0.281 <0.001 2.786 0.021
  3 years 0.221 0.019 2.148 0.175
  5 years 0.237 0.015 1.078 0.674

Abbreviations: G-KV/R-BSA, ratio of graft kidney volume to recipient body surface area; G-KW/R-BW, ratio of graft kidney weight to recipient body weight; eGFR, estimated glomerular filtration rate.

Table 5.
Factors affecting to graft function at 1, 3, 5 years post-transplantation: multivariate analysis
Variable P-value Odds ratio 95% CI
eGFR 60 (mL/min/1.73 m2) at 1 year post-transplantation      
  Recipient age (yr) 0.295 0.979 0.940∼1.019
  Donor age (yr) 0.950 0.999 0.959∼1.040
  Donor eGFR (mL/min/1.73 m2) 0.001 1.048 1.019∼1.079
  Degree of HLA match (≥4) 0.214 0.566 0.231∼1.390
  D-BSA/R-BSA (≥1.0) 0.005 4.915 1.621∼14.903
  G-KV/R-BSA (≥84.0 mL/m2) 0.035 3.011 1.083∼8.375
  G-KW/R-BW (≥3.2 g/kg) 0.076 0.346 0.107∼1.120
eGFR 60 (mL/min/1.73 m2) at 3 years post-transplantation      
  Recipient age (yr) 0.210 0.971 0.927∼1.017
  Donor age (yr) 0.354 0.979 0.935∼1.024
  Donor eGFR (mL/min/1.73 m2) 0.004 1.044 1.014∼1.075
  Degree of HLA match (≥4) 0.347 0.627 0.237∼1.657
  D-BSA/R-BSA (≥1.0) 0.366 1.664 0.552∼5.018
  G-KV/R-BSA (≥84.0 mL/m2) 0.280 1.859 0.604∼5.722
  G-KW/R-BW (≥3.2 g/kg) 0.536 0.680 0.200∼2.309
eGFR 60 (mL/min/1.73 m2) at 5 years post-transplantation      
  Recipient age (yr) 0.251 1.043 0.970∼1.122
  Donor age (yr) 0.009 0.916 0.857∼0.979
  Donor eGFR (mL/min/1.73 m2) 0.095 1.038 0.994∼1.084
  Degree of HLA match (≥4) 0.916 0.928 0.231∼3.731
  D-BSA/R-BSA (≥1.0) 0.746 0.780 0.174∼3.504
  G-KV/R-BSA (≥84.0 mL/m2) 0.698 1.383 0.994∼1.084
  G-KW/R-BW (≥3.2 g/kg) 0.035 3.628 1.097∼12.005

Abbreviations: CI, confidence interval; eGFR, estimated glomerular filtration rate; HLA, human leukocyte antigen; D-BSA/R-BSA, ratio of donor body surface area to recipient body surface area; G-KV/R-BSA, ratio of graft kidney volume to recipient body surface area; G-KW/R-BW, ratio of graft kidney weight to recipient body weight.

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