Lower donated kidney volume is associated with increased risk of lower graft function and acute rejection at 1 year after living donor kidney—a retrospective study

Abstract

Summary Kidney volume has been proven to be a surrogate marker of nephron mass and renal function. We studied 190 donor and recipient pairs undergoing living donor kidney transplantation at our institution during 9 years. Different metrics of donor kidney volume (DKV) were explored: alone or indexed to recipient’s anthropometry, as body surface area (BSA). DKV/BSA (min. 49.7; P33rd 77.7; P67th 95.3; max. 176 cm3/m2) was chosen given its higher correlation with eGFR at 1 year, and recipients were divided according to its tertiles (T). The eGFR at 1 year was lower in T1, when compared with T2 (P = 0.015) and T3 (P < 0.001). In a multivariable model, a regression spline revealed that a DKV/BSA lower than 80 was significantly associated with an eGFR at 1 year <60. In the first 6 years, the overall annual eGFR slope was −0.90 ml/min/year. Acute rejection occurred in 19%, 11%, and 0% of patients in T1, T2, and T3, respectively (P < 0.001). DKV/BSA increased stepwise from cellular‐ (n = 12) to antibody‐mediated (n = 7) AR cases and to those without AR (n = 171; P = 0.002; no AR versus cellular AR). Lower DKV/BSA ratio was associated with significantly worse graft function and higher incidence of AR. Hence, it can be a tool for better selection of donors in order to improve graft outcomes, particularly in the setting of multiple potential living donors or kidney paired exchange programs.

CT volumetry performs better than nuclear renography in predicting estimated renal function one year after living donation

“…The remaining kidney volume indexed to weight (RKV/W) was found to be a strong predictor of estimated glomerular filtration rate at 1 year and mid-term renal function after living-donor nephrectomy [ 29 ]. Considering recipients´ perspectives, we showed that lower donated kidney volume was associated with an increased risk of lower graft function one year after living donor transplant and suggested it can be a tool for better selection of donors to improve graft outcomes, particularly in the setting of multiple potential living donors or kidney paired exchange programs [ 30 ].…”

Biologically Unrelated Living Donor for Kidney Transplantation Associated With Higher Acute Rejection Rate but With Similar Graft Survival of a Related Living Donor

“…All enrolled recipients had similar triple maintenance immunosuppression consisting of oral tacrolimus, mycophenolate mofetil (MMF), and methylprednisolone (MP)/prednisolone. Further details of our regimen have already been published [ 16 ].…”

“…The HLA-incompatible KT received desensitization with intravenous immunoglobulin (2 g/kg) at transplant (0.5 g/kg immediately before transplant, and on days 1, 2, and 3) and one month after transplantation (1 g/kg in two consecutive days), and a dose of rituximab (375 mg/ m2) on day 3 post-transplant. Given the strength of preformed anti-HLA DSA and flow cytometry crossmatch results, six patients also underwent plasmapheresis every other day (the first session three days before the transplant, for a total of six to nine sessions) [ 16 ].…”

Clinical performance of the iPREDICTLIVING tool for the prediction of the post‐transplant recipient and living donor outcomes in a European cohort

“…All enrolled recipients had similar triple maintenance immunosuppression, consisting of a calcineurin inhibitor (most of them tacrolimus or, less often, cyclosporine), mycophenolate mofetil, and prednisolone. 17 Incompatible KT includes cases of HLA-incompatible KT, in which a transplant occurred with preformed donor-specific antibodies (DSA), and cases of ABO-incompatible KT, in which there was a blood group incompatibility. Both situations were submitted to desensitization protocols that included treatment with rituximab, plasmaphereses, and intravenous immunoglobulin.…”