Introduction: Long-term kidney function depends on multiple factors. One of the factors that may affect survival and function of kidney graft is the functional mass of the graft. Methods: In order to study whether graft mass may be a determinant outcome after kidney transplantation we investigated the impact of the ratio between donor kidney weight (DKW) in grams and recipient body weight (RBW) in kilograms on serum creatinine values, creatinine clearance (calculated as MDRD) and proteinuria. In addition, a pretransplant biopsy was performed and the histological results graded on the basis of Remuzzi score. Delayed graft function, number of rejection episodes and graft survival were also considered. Donor and recipient data were collected at the time of inclusion and then at each follow-up (3, 6, 12, 24 and 36 months after transplantations). One hundred fifty-four kidneys were weighed immediately before grafting; the donors were 95 males and 59 females, mean age was 49±14 years, and mean body weight was 72±15 Kg while the recipients were 89 males and 65 females, mean age was 50±12 and mean body weight was 64±12 Kg. The mean HLA incompatibility was 3±1. The mean kidney weight was 227±59 g. The delayed graft function rate was 12.5% and 24.3% of patients experienced at least one episode of acute rejection. Results: The random coefficient model that we fitted showed significant lower values of creatinine clearance in patients with DKW/ RBW ratio <3g/kg and between 3 and 4 g/kg compared to those with DKW/RBW ratio > 4 g/kg and this difference was significant in all time points of the follow-up. In addition, there was a significant increase in creatinine clearance values in the patients with DKW/RBW <3 g/kg comparing the third to the first month post-transplantation. Other parameters showed to influence significantly creatinine clearance values such as donor and recipient gender, number of acute rejection episodes and donor age. It is interesting to note that there was a remarkable effect of donor/recipient gender on filtration rate when donor and/or recipient was female, suggesting that gender has an effect which is not only due to kidney weight differences. We showed significantly greater occurrence of proteinuria (defined as >0.5g/24h) and earlier appearance in the recipients with DKW/ RBW ratio <2.5g/kg (Hazard ratio=3.6, p<0.001) by mean of Cox proportional-hazards model analysis. Remuzzi score did not influence the apparition of proteinuria, filtration rate and DGF. The incidence of DGF was influenced by HLA mismatches and recipient/donor gender while it was not influenced by DKW/RBW ratio, which neither influenced graft survival. Conclusion: These data confirm the importance of graft mass on renal function, particularly in the first period after transplantation.
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