Impact of graft mass on the clinical outcome of kidney transplants |
| |
Authors: | Giral Magali Nguyen Jean Michel Karam Georges Kessler Michelle Hurault de Ligny Bruno Buchler Mattias Bayle François Meyer Carole Foucher Yohann Martin Marie Laure Daguin Pascal Soulillou Jean Paul |
| |
Affiliation: | Institut de Transplantation et de Recherche en Transplantation and Inserm U437 (Immunointervention dans les Allo et Xénotransplantation), 30 bd Jean Monnet, 44093, Nantes, France. |
| |
Abstract: | The effect of nephronic mass reduction of kidney transplants has not been analyzed specifically in a large cohort. Transplant injuries in cadaver kidney graft may have led to an underestimation of the magnitude of this factor. The aim of this study was to analyze the consequences of kidney mass reduction on transplantation outcome. The weights of 1142 kidney grafts were collected prospectively immediately before grafting. Donors and recipients <15 yr of age, simultaneous kidney/pancreas grafts, and technical failures before day 7 were excluded from the analysis. The analysis was performed on Cockroft-calculated creatinine clearance and proteinuria in 964 patients for whom all of the necessary information was available. This study reports that the smallest kidneys transplanted into the largest recipients (donor kidney weight/recipient body weight [DKW/RBW] <2 g/kg, n = 88) increased their clearance by 2.38 ml/min every month for 6 mo (P < 0.0001) and by 0.27 ml/min thereafter (P < 0.0001). Conversely, creatinine clearance did not change for the largest kidneys transplanted into the smallest recipients (DKW/RBW ratios >/=4 g/kg). Next, using a Cox model analysis, it was shown that the risk of having a proteinuria >0.5 g/kg was significantly increased for the low DKW/RBW ratios <2 g/kg with 50% of patients having a proteinuria, compared with DKW/RBW ratios >/=4 g/kg (P < 0.001). In cadaver transplant recipients, graft mass has a rapid impact on graft filtration rate and proteinuria. Avoiding major kidney/recipient inadequacy should have a significant influence on long-term transplant function. |
| |
Keywords: | |
本文献已被 PubMed 等数据库收录! |
|