The effect of donor/recipient body surface area ratio on outcomes in pediatric kidney transplantation.
In pediatric kidney transplantation, the effect of inadequate nephron dosing on graft survival remains undetermined. The aim of this study was to assess the use of D/R BSA, as a reliable indicator of adequate nephron dosing, and eventually a tool to optimize pediatric graft allocation. Following Institutional Review Board approval, we reviewed deceased donor pediatric kidney transplantation (N = 156). We divided patients into three groups, based on D/R BSA: A < or =0.8; B 0.81-1.19; C > or =1.2. Five-yr graft survival rates in the groups were: A 82.0%; B 94.9%; C 97.1% (p = 0.01). Group C had the lowest rate of acute rejection, suggesting a protective effect of increased D/R BSA (group A = 35.7%, group B = 38.9%, group C = 18.8%; p = 0.029). The logistic regression analysis showed that decreased D/R BSA ratio is a risk factor for loss of graft function, at one and five yr [i.e., group A OR 6 (95% CI 1.14-39.30, p = 0.015) and OR 4.49 (95% CI 1.46-13.79, p = 0.009), respectively]. We conclude that for pediatric recipients, D/R BSA is a valuable adjunct when determining long-term graft survival. Its utility may avoid an alloimmune-independent risk factor, increasing the long-term protective value of a good matching policy.
Giuliani
Stefano
S
Division of Pediatric Surgery, Department of Pediatrics, University of Padova, Padova, Italy. stegiuliani@hotmail.com
Gamba
Pier Giorgio
PG
Chokshi
Nikunj Kanu
NK
Gasparella
Paolo
P
Murer
Luisa
L
Zanon
Giovanni Franco
GF
D000293:Adolescent; D001830:Body Surface Area; D002648:Child; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D009929:Organ Size; D014019:Tissue Donors; D016896:Treatment Outcome