title: Preoperative renal volumes as a predictor of graft function in living donor transplantation.
abstract: BACKGROUND
  Nephron underdosing and donor kidney-recipient body size mismatch can lead to poor allograft function. The purpose of this study is to examine the relationship between donor kidney volume and posttransplantation graft function by using magnetic resonance imaging (MRI) to obtain renal volumes. Previous investigators used donor body surface area as a surrogate for kidney size or measured renal volume by using ultrasonography; both these techniques are inaccurate measures of renal volume. Intraoperative weights are more accurate, but provide information only after the transplantation is underway. More recently, MRI has been used preoperatively to screen living donors; these novel MRI techniques also provide information regarding renal size.
  
  
  METHODS
  We performed a retrospective analysis of 54 patients who underwent living donor transplantation at our institution from 2000 to 2002. All living donors underwent preoperative renovascular imaging using MRI, and renal volumes were obtained for each donor. A transplant kidney volume-recipient body weight (Vol/Wt) ratio was determined for each donor-recipient pair, and patients were divided into tertiles corresponding to 3 groups: high (>2.7), medium (2 to 2.7), and low (<2) "nephron dose" ratios.
  
  
  RESULTS
  Glomerular filtration rate (GFR) correlated with Vol/Wt ratio at 6 and 12 months (r = 0.46; P = 0.0005 and r = 0.41; P = 0.003). At 6 months, mean GFRs in the low, medium, and high groups were 52.4 +/- 2.8 (SEM), 64.5 +/- 6.2, and 82.0 +/- 4.4 mL/min, respectively (P < 0.0005). At 12 months, GFRs in the low, medium, and high groups were 51.6 +/- 3.6, 63.3 +/- 3.8, and 83.9 +/- 5.4 mL/min, respectively (P < 0.0001).
  
  
  CONCLUSIONS
  Transplantation of donor-recipient pairs with a Vol/Wt ratio less than 2 cm 3 /kg was associated with significantly worse graft function. Donor kidney volumes measured by means of preoperative MRI can be used to calculate Vol/Wt ratios before transplantation and identify patients at risk for a low GFR posttransplantation.
authors.affiliation: Division of Nephrology, Stanford University Medical Center, Stanford, CA 95025, USA.
authors.forename: Anjali B
authors.initials: AB
authors.lastname: Saxena
authors.forename: Stéphan
authors.initials: S
authors.lastname: Busque
authors.forename: Philippe
authors.initials: P
authors.lastname: Arjane
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Myers
authors.forename: Jane C
authors.initials: JC
authors.lastname: Tan
mesh_terms: D000328:Adult; D049628:Body Size / Q000502:physiology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007432:Intraoperative Period; D007668:Kidney / Q000098:blood supply / Q000502:physiology*; D016030:Kidney Transplantation / Q000502:physiology*; D019520:Living Donors; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009399:Nephrons / Q000098:blood supply / Q000502:physiology; D009929:Organ Size / Q000502:physiology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies