title: The effect of donor/recipient body surface area ratio on outcomes in pediatric kidney transplantation.
abstract: 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.
authors.affiliation: Division of Pediatric Surgery, Department of Pediatrics, University of Padova, Padova, Italy. stegiuliani@hotmail.com
authors.forename: Stefano
authors.initials: S
authors.lastname: Giuliani
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Gamba
authors.forename: Nikunj Kanu
authors.initials: NK
authors.lastname: Chokshi
authors.forename: Paolo
authors.initials: P
authors.lastname: Gasparella
authors.forename: Luisa
authors.initials: L
authors.lastname: Murer
authors.forename: Giovanni Franco
authors.initials: GF
authors.lastname: Zanon
mesh_terms: 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