Comparison of live donor predonation and post‐transplant kidney volumes and glomerular size in pediatric patients weighing less than 15 kg – a retrospective study

Muramatsu, Masaki; Hamasaki, Yuko; Mizutani, Toshihide; Takahashi, Yusuke; Hashimoto, Junya; Kubota, Masashi; Oguchi, Hideyo; Yonekura, Tatsuro; Sakurabayashi, Kei; Aoki, Yujiro; Shinoda, Kazunobu; Itabashi, Yoshihiro; Kawamura, Takeshi; Shiraga, Nobuyuki; Mikami, Taisei; Shibuya, Kazutoshi; Sakai, Ken; Shishido, Seiichiro

doi:10.1111/tri.13602

Cited by 4 publications

(5 citation statements)

References 20 publications

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“…It seems that compensatory mechanisms exist that regulate the size of the transplanted kidney, by regulating the size of its glomeruli mainly, to meet the recipient's metabolic needs as they are indicated by his/her body size 9,10,22,28,29 . Müller‐Deile et al 28 reported that there is a significant increase in renal graft size within the first 6 months after renal transplant when an infant donates to a child or an adult, and when a child donates to an adult.…”

Section: Discussionmentioning

confidence: 99%

“…28 Nevertheless, the resultant hyperfiltration and increased mechanical stress leads to glomerulosclerosis and proteinuria, with a negative impact on renal graft function and survival. 9,10,28 On the other hand, Muramatsu et al 29 showed that the renal graft volume is decreased in pediatric recipients weighing less than 15 kg when they receive a kidney from an adult donor, by 17.2% on average at 1 year after renal transplant, due to a reduction in the size of its glomeruli. Furthermore, Amesty et al 22 compared adult size with size-matched renal transplants in pediatric recipients weighing less than 20 kg.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric renal transplantation—A UNOS database analysis of donor–recipient size mismatch

Kostakis

Chandak

Assia‐Zamora

et al. 2023

Pediatric Transplantation

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Background We used the BSAi (Donor BSA/Recipient BSA) to assess whether transplanting a small or large kidney into a pediatric recipient relative to his/her size influences renal transplant outcomes. Methods We included 14 322 single‐kidney transplants in pediatric recipients (0–17 years old) (01/2000–02/2020) from the United Network for Organ Sharing database. We divided cases into four BSAi groups (BSAi ≤ 1, 1 < BSAi ≤ 2, 2 < BSAi ≤ 3, BSAi > 3). Results There were no differences concerning delayed graft function (DGF) or primary non‐function (PNF) rates, whether the grafts were from living or brain‐dead donors. In both transplants coming from living donors and brain‐dead donors, cases with BSAi > 3 and cases with 2 < BSAi ≤ 3 had similar graft survival (p = .13 for transplants from living donors, p = .413 for transplants from brain‐dead donors), and both groups had longer graft survival than cases with 1 < BSAi ≤ 2 and cases with BSAi ≤ 1 (p < .001). The difference in 10‐year graft survival rates between cases with BSAi > 3 and cases with BSAi ≤ 1 reached around 25% in both donor types. The better graft survival in transplants with BSAi > 2 was confirmed in multivariable analysis. Conclusions There is no significant impact of donor‐recipient size mismatch on DGF and PNF rates in pediatric renal transplants. However, graft survival is significantly improved when the donor's size is more than twice the pediatric recipient's size.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pediatric renal transplantation—A UNOS database analysis of donor–recipient size mismatch

Kostakis

Chandak

Assia‐Zamora

et al. 2023

Pediatric Transplantation

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“…Similarly, renal functional and structural adaptations have been observed when an adult kidney is transplanted in pediatric patients with a smaller body size, creating another form of size mismatch glomerular appearance [ 20 , 21 ]. The functional adjustment with regard to glomerular filtration rate to the body surface area is known to happen within 3 months after transplant [ 20 ].…”

Section: Size Mismatch (Pediatric Donor Related) Glomerulopathy Secon...mentioning

confidence: 99%

“…The functional adjustment with regard to glomerular filtration rate to the body surface area is known to happen within 3 months after transplant [ 20 ]. However, in one study, morphologic changes in terms of posttransplant reduction in kidney volumes and size of the glomeruli were also documented at the end of 1 year [ 21 ]. These changes have been shown partly as a consequence of pretransplant abdominal cavity and posttransplant weight gain and somatic growth [ 21 ].…”

Section: Size Mismatch (Pediatric Donor Related) Glomerulopathy Secon...mentioning

confidence: 99%

“…However, in one study, morphologic changes in terms of posttransplant reduction in kidney volumes and size of the glomeruli were also documented at the end of 1 year [ 21 ]. These changes have been shown partly as a consequence of pretransplant abdominal cavity and posttransplant weight gain and somatic growth [ 21 ].…”

Section: Size Mismatch (Pediatric Donor Related) Glomerulopathy Secon...mentioning

confidence: 99%

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De novo Glomerular Disease and the Significance of Electron Microscopy in Renal Transplantation

Seshan¹,

Salvatore²

2021

Glomerular Dis

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Background: De novo glomerular diseases comprising those both common and unique to transplant may develop in the renal allograft leading to posttransplant proteinuria, hematuria, or allograft failure. Electron microscopy (EM) is a useful adjunct to the standard light and immunofluorescence microscopy for accurately diagnosing these diseases and subsequently aiding the clinician in initiating appropriate treatments. Summary: De novo diseases are those new-onset diseases in renal transplantation that are unrelated to the original kidney disease in the recipient. They include virtually any primary or secondary glomerular, tubulointerstitial, or vascular diseases, ranging from subclinical to clinically overt, having acute, subacute, or chronic clinical presentations. This review focuses on common or significant, mainly glomerular, entities, with particular attention to the EM findings. The time of onset, stage, and severity of these diseases may often be modified by the current immunosuppressive protocols and other donor and recipient predisposing characteristics. Key Messages: A renal allograft biopsy not only improves our understanding of the pathophysiology but also provides diagnostic accuracy prognostic information, and potential for reversibility. In some cases, the biopsy leads to detection of unsuspected or clinically asymptomatic de novo diseases in the setting of other concomitant rejection processes, infection, or toxicity, which can dictate appropriate therapy. Routine EM in transplant kidney biopsies is a valuable modality in recognizing fully developed or early/subtle features of evolving de novo diseases, often during the subclinical phases, in “for cause” or surveillance/protocol allograft biopsies.

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Changes in graft function after living donor kidney transplantation in children

et al. 2022

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Comparison of live donor predonation and post‐transplant kidney volumes and glomerular size in pediatric patients weighing less than 15 kg – a retrospective study

Cited by 4 publications

References 20 publications

Pediatric renal transplantation—A UNOS database analysis of donor–recipient size mismatch

Pediatric renal transplantation—A UNOS database analysis of donor–recipient size mismatch

De novo Glomerular Disease and the Significance of Electron Microscopy in Renal Transplantation

Changes in graft function after living donor kidney transplantation in children

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