Kidney and recipient weight incompatibility reduces long-term graft survival.
Long-term function of kidney allografts depends on multiple variables, one of which may be the compatibility in size between the graft and the recipient. Here, we assessed the long-term consequences of the ratio of the weight of the kidney to the weight of the recipient (KwRw ratio) in a multicenter cohort of 1189 patients who received a transplant between 1995 and 2006. The graft filtration rate increased by a mean of 5.74 ml/min between the third and sixth posttransplantation months among patients with a low KwRw ratio (<2.3 g/kg; P<0.0001). In this low KwRw ratio group, the graft filtration rate remained stable between 6 months and 7 years but then decreased at a mean rate of 3.17 ml/min per yr (P<0.0001). In addition, low KwRw ratios conferred greater risk for proteinuria, more antihypertensive drugs, and segmental or global glomerulosclerosis. Moreover, a KwRw ratio<2.3 g/kg associated with a 55% increased risk for transplant failure by 2 years of follow-up. In conclusion, incompatibility between graft and recipient weight is an independent predictor of long-term graft survival, suggesting that avoiding kidney and recipient weight incompatibility may improve late clinical outcome after kidney transplantation.
Giral
Magali
M
Institut de Transplantation et de Recherche en Transplantation, ITERT, CHU Nantes, Réseau Thématique de Recherche et de Soins Centaure, Nantes and INSERM U643 (Immunointervention dans les Allo et Xénotransplantation), Centre d'Investigation Clinique biothérapie, 30 bd Jean Monnet, 44093, Nantes, France.
Foucher
Yohann
Y
Karam
Georges
G
Labrune
Yann
Y
Kessler
Michelle
M
Hurault de Ligny
Bruno
B
Büchler
Mathias
M
Bayle
François
F
Meyer
Carole
C
Trehet
Nathalie
N
Daguin
Pascal
P
Renaudin
Karine
K
Moreau
Anne
A
Soulillou
Jean Paul
JP
D000328:Adult; D001835:Body Weight / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007668:Kidney / Q000033:anatomy & histology*; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size / Q000502:physiology; D011507:Proteinuria / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014180:Transplantation / Q000502:physiology*; D014184:Transplantation, Homologous; D016896:Treatment Outcome