title: Impact of graft mass on the clinical outcome of kidney transplants.
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.
authors.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.
authors.forename: Magali
authors.initials: M
authors.lastname: Giral
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Nguyen
authors.forename: Georges
authors.initials: G
authors.lastname: Karam
authors.forename: Michelle
authors.initials: M
authors.lastname: Kessler
authors.forename: Bruno
authors.initials: B
authors.lastname: Hurault de Ligny
authors.forename: Mattias
authors.initials: M
authors.lastname: Buchler
authors.forename: François
authors.initials: F
authors.lastname: Bayle
authors.forename: Carole
authors.initials: C
authors.lastname: Meyer
authors.forename: Yohann
authors.initials: Y
authors.lastname: Foucher
authors.forename: Marie Laure
authors.initials: ML
authors.lastname: Martin
authors.forename: Pascal
authors.initials: P
authors.lastname: Daguin
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Soulillou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D005260:Female; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology* / Q000502:physiology; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009399:Nephrons / Q000033:anatomy & histology / Q000502:physiology; D009929:Organ Size; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014019:Tissue Donors