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

Ho Eo Seong; Hyung Lee Su; Hwan Won Je; Chang-Kwon Oh

doi:10.4285/jkstn.2015.29.4.209

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

Original Article

J Korean Soc Transplant 2015;29(4):209-215.

Published online: 10 December 2015

DOI: https://doi.org/10.4285/jkstn.2015.29.4.209

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

Ho Eo Seong, M.D.¹, Hyung Lee Su, M.D.¹, Hwan Won Je, M.D.², Chang-Kwon Oh, M.D.¹

¹Departments of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea

²Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea

Corresponding author: Su Hyung Lee, Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: 82-31-219-5760, Fax: 82-31-219-4438 E-mail: dltngudgs@aumc.ac.kr

Received 31 July 2015 Revised 10 November 2015 Accepted 10 November 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Kidney transplantation, Graft volume, Graft weight, Graft function

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
Variable	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)
Variable	＜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
Variable	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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