title: Correlation of whole kidney hypertrophy with glomerular over-filtration in live, gender-mismatched renal transplant allografts.
abstract: OBJECTIVE
  Optimizing nephron supply to recipient demand is a non-immunologic determinant of renal allograft outcome. Nephron reduction is usually caused by physical donor-recipient mismatch, but its pathologic relevance remains to be determined.
  
  
  METHODS
  Thirty-one recipients of living donor renal transplants were divided into three subgroups: those who received transplants from the same gender (n = 6, Group 1) and those who underwent male-to-female (n = 8, Group 2) and female-to-male (n = 17, Group 3) transplants. Renal mass was evaluated by three-dimensional computed tomography (3D-CT) volumetry before and one year after transplantation. Glomerular volume was determined from protocol biopsies obtained one hour and one year after transplantation.
  
  
  RESULTS
  Histologically determined glomerular volume in biopsied tissues showed a significant linear correlation with allograft size on 3D-CT volumetry (P < 0.001, r = 0.625). Mismatches in body weight, glomerular volume and kidney volume ratios were significantly greater in female-to-male (Group 3) than in male-to-female (Group 2) transplants (P < 0.001 each). Despite the two groups having nearly equal graft filtration rates one year after transplantation, proteinuria rate was three-fold higher in Group 3 than in Group 2 (P < 0.001).
  
  
  CONCLUSIONS
  These findings suggest that too small graft size, frequent in female-to-male transplants, could cause hypertrophy in both kidneys and glomeruli, thereby affecting allograft function and survival.
authors: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors: Masaaki
authors: M
authors: Yanishi
authors: Second Department of Internal Medicine, Division of Nephrology, Kansai Medical University, Osaka, Japan.
authors: Hiroyasu
authors: H
authors: Tsukaguchi
authors: Second Department of Internal Medicine, Division of Nephrology, Kansai Medical University, Osaka, Japan.
authors: Nguyen Thanh
authors: NT
authors: Huan
authors: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors: Yuya
authors: Y
authors: Koito
authors: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors: Hisanori
authors: H
authors: Taniguchi
authors: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors: Kenji
authors: K
authors: Yoshida
authors: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors: Takao
authors: T
authors: Mishima
authors: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors: Motohiko
authors: M
authors: Sugi
authors: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors: Hidefumi
authors: H
authors: Kinoshita
authors: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors: Tadashi
authors: T
authors: Matsuda
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D006984:Hypertrophy; D021621:Imaging, Three-Dimensional; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous
keywords: gender mismatch; glomerular volume; hyperfiltration; kidney transplantation; kidney volume