title: The perfusion pressure in non-heart-beating donors may expand the glomeruli.
abstract: BACKGROUND
  We have observed expanded glomeruli in biopsies of kidneys from non-heart-beating donors (NHBDs). We sought to determine the differences in glomerular size between NHBDs and brain-dead donors and to assess whether glomerular size impacted graft outcome.
  
  
  METHODS
  We estimated the glomerular area using the maximal planar area (MPA) method in 198 pretransplant biopsies from 119 donors: 54 (45.4%) NHBDs and 65 (54.6%) brain-dead donors. Donor data and graft outcomes were correlated with MPA and percentage of glomerulosclerosis. The range of follow-up was 1 to 3 years. Uni- and multivariate analyses were performed.
  
  
  RESULTS
  MPA was larger among NHBDs. MPA and GS both significantly correlated with donor age. The association between MPA and age was independent of nephron loss (ie; GS). Increased glomerular size was only observed among donors younger than 50 years. Graft survival and function were not independently associated with MPA. Donor age was a better predictor of graft outcome.
  
  
  CONCLUSIONS
  The perfusion pressure used in NHBDs may expand the glomeruli, but this maneuver does not have any effect on graft outcome. Among donors without severe changes, glomerular size increment shows a limit around the sixth decade of life. In our study, MPA was not an independent predictor of graft survival or function.
authors.affiliation: Department of Pathology, Hospital Clínico San Carlos, Madrid, Spain. lfarias.udea@terra.es
authors.forename: L F
authors.initials: LF
authors.lastname: Arias
authors.forename: J
authors.initials: J
authors.lastname: Blanco
authors.forename: A
authors.initials: A
authors.lastname: Sánchez-Fructuoso
authors.forename: L
authors.initials: L
authors.lastname: Ortega
authors.forename: M A
authors.initials: MA
authors.lastname: Zuluaga
authors.forename: J
authors.initials: J
authors.lastname: Conesa
authors.forename: E
authors.initials: E
authors.lastname: Duque
authors.forename: M
authors.initials: M
authors.lastname: Sáiz-Pardo
authors.forename: J
authors.initials: J
authors.lastname: Ruiz
authors.forename: A
authors.initials: A
authors.lastname: Barrientos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002423:Cause of Death; D005260:Female; D006323:Heart Arrest; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011312:Pressure; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement