title: Live Donor Renal Anatomic Asymmetry and Posttransplant Renal Function.
abstract: BACKGROUND
  Relationship between live donor renal anatomic asymmetry and posttransplant recipient function has not been studied extensively.
  
  
  METHODS
  We analyzed 96 live kidney donors, who had anatomical asymmetry (>10% renal length and/or volume difference calculated from computerized tomography angiograms) and their matching recipients. Split function differences (SFD) were quantified with technetium-dimercaptosuccinic acid renography. Implantation biopsies at time 0 were semiquantitatively scored. A comprehensive model using donor renal volume adjusted to recipient weight (Vol/Wgt), SFD, and biopsy score was used to predict recipient estimated glomerular filtration rate (eGFR) at 1 year. Primary analysis consisted of a logistic regression model of outcome (odds of developing eGFR>60 mL/min/1.73 m(2) at 1 year), a linear regression model of outcome (predicting recipient eGFR at one-year, using the chronic kidney disease-epidemiology collaboration formula), and a Monte Carlo simulation based on the linear regression model (N=10,000 iterations).
  
  
  RESULTS
  In the study cohort, the mean Vol/Wgt and eGFR at 1 year were 2.04 mL/kg and 60.4 mL/min/1.73 m(2), respectively. Volume and split ratios between 2 donor kidneys were strongly correlated (r = 0.79, P < 0.001). The biopsy scores among SFD categories (<5%, 5%-10%, >10%) were not different (P = 0.190). On multivariate models, only Vol/Wgt was significantly associated with higher odds of having eGFR > 60 mL/min/1.73 m (odds ratio, 8.94, 95% CI 2.47-32.25, P = 0.001) and had a strong discriminatory power in predicting the risk of eGFR less than 60 mL/min/1.73 m(2) at 1 year [receiver operating curve (ROC curve), 0.78, 95% CI, 0.68-0.89].
  
  
  CONCLUSIONS
  In the presence of donor renal anatomic asymmetry, Vol/Wgt appears to be a major determinant of recipient renal function at 1 year after transplantation. Renography can be replaced with CT volume calculation in estimating split renal function.
authors.affiliation: 1 Division of Nephrology, UT Southwestern Medical Center, Dallas, TX. 2 Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY. 3 Department of Pathology, Columbia University College of Physicians and Surgeons, New York, NY. 4 Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY. 5 Booth School of Business, University of Chicago, Chicago, IL. 6 Renal Transplantation, New York Presbyterian Hospital, New York, NY. 7 Renal and Pancreatic Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Bekir
authors.initials: B
authors.lastname: Tanriover
authors.forename: Sonalis
authors.initials: S
authors.lastname: Fernandez
authors.forename: Eric S
authors.initials: ES
authors.lastname: Campenot
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Newhouse
authors.forename: Irina
authors.initials: I
authors.lastname: Oyfe
authors.forename: Prince
authors.initials: P
authors.lastname: Mohan
authors.forename: Burhaneddin
authors.initials: B
authors.lastname: Sandikci
authors.forename: Jai
authors.initials: J
authors.lastname: Radhakrishnan
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Wexler
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Carroll
authors.forename: Sairah
authors.initials: S
authors.lastname: Sharif
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Ratner
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hardy
mesh_terms: D000328:Adult; D003198:Computer Simulation; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D016014:Linear Models; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D009519:New York City; D016017:Odds Ratio; D009929:Organ Size; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome