Clinical implication of renal allograft volume to recipient body surface area ratio in pediatric renal transplant

Abstract

Our study aims to assess the clinical implication of RAV/rBSA ratio in PRT as a predictor for attained renal function at 1 year post‐transplantation and its association with surgical complications. A retrospective cohort was performed for PRT cases from January 2000 to December 2015 in our institution. Extracted clinical information includes the recipient's demographics, donor type, renal allograft characteristics, arterial, venous and ureteral anastomoses, vascular anastomosis time while kidney off ice, overall operative time, and estimated blood loss. The RAV/rBSA was extrapolated and assessed for its association with renal graft function attained in 1 year post‐transplantation and surgical complications within 30‐day post‐transplantation. A total of 324 PRTs cases were analyzed. The cohort consisted of 187 (52.4%) male and 137 (42.3%) female recipients, with 152 (46.9%) living donor and 172 (53.1%) deceased donor renal transplants, and an overall median age of 155.26 months (IQR 76.70‐186.98) at time of renal transplantation. The receiver operating characteristic identified that a RAV/rBSA ratio of 135 was the optimal cutoff in determining the renal graft function outcome. Univariate and multivariate analyses revealed the relative OR for RAV/rBSA ≥ 135 ratio in predicting an eGFR ≥ 90 attained within 1 year post‐transplant was highest among younger pediatric recipients (<142.5 months) of deceased kidney donors (OR = 11.143, 95% CI = 3.156‐39.34). Conversely, Kaplan‐Meier analysis revealed that RAV/rBSA ratio ≥ 135 is associated with lower odds of having eGFR <60 (OR = 0.417, 95% CI = 0.203‐0.856). The RAV/rBSA ratio was not associated nor predictive of transplant‐related surgical complications. Our study determined that the RAV/rBSA ratio is predictive of renal graft function at 1‐year PRT, but not associated with any increased surgical complications.

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

“…Relatively few studies have attempted to assess the impact of the size of the transplanted kidney relative to the recipient's size in pediatric renal transplantation, reporting varying results in small patient numbers. [19][20][21][22][23] Chua et al 19 reported worse renal graft function at 1 year after transplant in recipients less than 12 years old when the ratio of renal graft volume to recipient's BSA was less than 135. On the contrary, de Petris et al 20 did not detect any association between the ratio of renal graft volume to the recipient's BSA and medium-term renal graft function.…”

“…[15][16][17][18] However, the role of renal graft size, and size mismatch between donor and recipient has not been adequately investigated in the pediatric population, with only a small number of studies looking into this. [19][20][21][22][23][24] Pediatric renal transplant recipients represent a unique population with respect to challenges in size mismatch, which are more obvious the younger the child is. Renal grafts for pediatric recipients are derived from adult living donors, adult deceased donors, or pediatric deceased donors, resulting in a wide range of donor-recipient size ratio, and therefore, a wide range of renal graft size relative to recipient's size.…”

“…Thus, a few studies have tried to use the donor's size as an indirect way to evaluate renal graft size and assess the role of size mismatch between donor and recipient in renal transplantation, mainly focusing on adult population 15–18 . However, the role of renal graft size, and size mismatch between donor and recipient has not been adequately investigated in the pediatric population, with only a small number of studies looking into this 19–24 …”

Utility of pre‐transplant lower urinary tract investigation in pediatric renal transplant population after referral: A 16‐year institutional experience

“…The primary clinical outcome was the number of LUT investigations performed after referral of RT (defined as all investigations within the prior 1 year of transplant) that led to urologic interventions. Secondary outcomes were 1 year clinical outcomes: Clavien–Dindo complications ≥ 3, estimated glomerular function (eGFR) ≥ 60 ml/min/1.73 m 2 , eGFR ≥ 90 ml/min/1.73 m 2 , and graft loss 7,8 . The collected data were internally validated through a random counter‐verification of 15% of the total extracted data.…”

“…Secondary outcomes were 1 year clinical outcomes: Clavien-Dindo complications ≥ 3, estimated glomerular function (eGFR) ≥ 60 ml/ min/1.73 m 2 , eGFR ≥ 90 ml/min/1.73 m 2 , and graft loss. 7,8 The collected data were internally validated through a random counterverification of 15% of the total extracted data. An additional validation was performed using the institutional chronic kidney disease database, which is maintained separately from the electronic patient database.…”