Clinical and pathological features of donor/recipient body weight mismatch after kidney transplantation

Abstract

Background Previous studies have shown that a donor/recipient body weight mismatch affects long‐term graft survival and graft function after kidney transplantation. However, the mechanisms are not fully understood. Aim To address the mechanisms, we compared the pathological and physiological features between patients with a donor/recipient body weight mismatch and those without a mismatch 1 yr after kidney transplantation. Furthermore, we investigated the correlation with the donor/recipient body weight ratio. Methods We examined allograft biopsy specimens from 10 recipients with stable kidney function, with body weight mismatch (donor/recipient body weight ratio [D/R BWR] < 0.9), and compared them with samples from 13 patients without mismatch. We measured glomerular volume (GV) using the Weibel–Gomez method and glomerular density (GD) defined by nonsclerotic glomerular number/renal cortical area as pathological findings. The physiological parameters included estimated glomerular filtration rate and proteinuria (mg/day). These data were evaluated to identify a correlation with D/R BWR. Results The pathological features showed that GV and GD were identical in the two groups. However, when glomerular enlargement was defined by ΔGV (GV at the 1‐yr biopsy minus GV at baseline biopsy), ΔGV was higher in mismatch cases compared with that in cases without a mismatch (10.6 ± 4.6 vs. 5.5 ± 7.1 × 105 μm3; P = 0.049). Furthermore, D/R BWR was significantly correlated with ΔGV (P = 0.03, r = –0.436). eGFR values were physiologically identical between the two groups, but the mismatch cases had significantly higher proteinuria levels than that of the cases without a mismatch at 1 yr after kidney transplantation. Conclusion A donor/recipient body weight mismatch could affect glomerular enlargement and increased proteinuria 1 yr after kidney transplantation. How these two features affect long‐term graft survival and function must be addressed in the future.

Correlation of whole kidney hypertrophy with glomerular over‐filtration in live, gender‐mismatched renal transplant allografts

“…This may be associated with renal size mismatch, resulting from female grafts being transplanted into males. Some studies have focused on mismatches in total body weight . Large body weight incompatibility (donor/recipient body weight ratio (BWR) < 0.9) resulted in greater glomerular enlargement than when BWs were more evenly matched (BWR > 0.9) .…”

“…The present study showed that increases in BW‐ratio, GV‐ratio, and KV‐ratio were significantly greater in Group 3 than in Group 2. Since both recipient body weight and GW‐ratio were significantly greater in Group 3 than in Group 2, the differences between these two groups may reflect differences in body size . Because transplantation of kidneys with fewer nephrons into recipients with relatively higher demand may have a deleterious impact on patient outcomes, body weight should be considered in evaluating donors and recipients.…”

“…Determining whether donor graft capacity can meet recipient metabolic demand is important in predicting graft survival and donor outcomes. Earlier studies have used donor body surface area, donor body weight, renal graft weight and cross‐sectional renal area on ultrasound as surrogate markers of nephron mass . We previously reported that the mean volume of the pretransplant grafted kidney increased approximately 27% after transplantation, with graft growth being most prominent in grafts from female donors to male recipients .…”

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“…How these two features affect long-term graft survival and function must be addressed in the future. 11 Likewise, in the study of Seo and associates, nephron mass (donor kidney weight-to-recipient body weight ratio) was an independent risk factor for graft failure. 12 Another study indicated that kidney graft weight can be estimated by donor sex and body mass index; results of this study demonstrated that graft weight is an important factor in the prediction of renal function 12 months after transplant, and it can be a useful parameter during the selection process of recipients.…”

Association Between Galactose-Deficient IgA1 Derived From the Tonsils and Recurrence of IgA Nephropathy in Patients Who Underwent Kidney Transplantation

“…Thirty-six patients with ESKD and biopsy-proven primary IgAN received kidney transplants at the Jikei University School of Medicine (Tokyo, Japan) from May 1988 to June 2014. Some cases were involved in previous studies using the same database (9,10). All patients received allografts from living related and unrelated donors.…”