Does Donor Nephron Mass Have Any Impact on Graft Survival?

Taherimahmoudi, M.; Mehrsai, Abdolrasoul; Nikoobakht, Mohammad Reza; Saraji, A.; Emamzadeh, A.; Pourmand, G.

doi:10.1016/j.transproceed.2007.03.084

Cited by 13 publications

(3 citation statements)

References 13 publications

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“…However, in the long term, no significant correlation was found between graft survival and nephron mass index. 28 The reported patient survival in this study is comparable with other single center reported survival results. 29 It is worth mentioning that the immunosuppression protocols was changed in our unit from cyclosporine based to tacrolimus based in 2002.…”

Section: Abbreviations: Cum Cumulativesupporting

confidence: 88%

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2016

Exp Clin Transplant

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Objectives: We evaluated risk factors that could adversely affect outcomes from elderly deceaseddonor transplants. Materials and Methods:In this single center retrospective study (112 patients), we studied the impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short-and long-term graft survival. Results: Mean ages of donors and recipients were 64.71 ± 4.09 and 50.39 ± 13.72 years. Delayed graft function was 40.2%, whereas acute rejection episode rate was 38%. Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years. Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome. Acute rejection episode was an independent predictor of graft outcome (β level = 2.857, t test = 2.3, P = .025). Donor age was a predictor of total graft survival duration (log-rank test gave chi-square test with 2 df = 12.292, P = .002). Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min (log-rank test gave chi-squared test with 1 df = 7.213, P = .007). Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome (P > .05), whereas acute rejection episodes (hazard ratio 5.443; 95% confidence interval, 2.226-15.311; P < .001) and donor estimated glomerular filtration rate (hazard ratio 0.449; 95% confidence interval, 0.209-0.945; P = .035) remained significant predictors of cumulative graft survival. Conclusions:The risk factors mentioned above should be avoided to achieve better graft survival. Emphasis should not be on donor age alone. Good donor kidney function and proper immunosuppressive therapy to reduce acute rejection episodes are cornerstones to improved outcomes.

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Section: Abbreviations: Cum Cumulativesupporting

confidence: 88%

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2016

Exp Clin Transplant

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“…Of the 351 recipients, 208 were men and 143 were women. The mean age of the recipients was 37 yr (median, 38; interquartile range [IQR], 27-48), and the mean age of the donors was 38 yr (median, 38; IQR, [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. All transplants were ABO compatible.…”

Section: Baseline Characteristics Of Recipients and Donorsmentioning

confidence: 99%

Graft volume as the surrogate marker for nephron number affects the outcomes of living‐donor kidney transplantation

Han

Yang

et al. 2011

Clinical Transplantation

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Post-transplant outcome of kidney allografts depends on various factors, one of which may be the compatibility in volume between graft and recipient. However, previous studies adjusted the graft volume only for recipient's size. As the adjusted graft volume for donor's size would be substituted of nephron number more accurately, we adjusted the graft volume for both recipient's and donor's sizes. In 351 cases of living-donor kidney transplantation, we found that the adjusted graft volume for both recipient's and donor's body surface areas (BSAs) yielded larger area under the curves for the transplant outcomes than looking only at the adjusted volume for the recipient's BSA. The recipients were separated into two groups according to the low and high adjusted graft volumes. During the follow-up period (mean 55.6 months), the low-graft-volume group conferred greater risk of rejection, chronic change, glomerulonephritis, and graft loss than the high-graft-volume group (all p's < 0.05). However, the frequency of T-cell infiltration, as evaluated in protocol biopsy, was not different between the two adjusted graft volume groups. In conclusion, the graft volume as the surrogate marker for nephron number should be considered in kidney transplantation, especially in otherwise similar donor conditions.

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“…These features represent the summated effects of tissue injury from multiple pathogenic insults combined with the kidney's fibrotic healing response. 3 Hyperfiltration injury from inadequate nephron mass may cause progressive injury in transplanted kidneys. 4 A recent study on functional nephron mass suggested that incompatibility between kidney graft weight and recipient body weight was an independent predictor of long-term renal allograft survival.…”

Section: Introductionmentioning

confidence: 99%

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Simforoosh

Soltani²,

Kashi³

et al. 2017

Exp Clin Transplant

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Objectives: Our objective was to evaluate the effect of kidney graft weight-to-recipient body weight ratio as a nonimmune factor that may affect long-term graft function. Materials and Methods:We retrospectively collected data from 2531 living donor kidney transplant procedures performed between 1994 and 2010 at Shahid Labbafinejad Medical Center; 635 patients were included in this study. Each kidney was weighed after cold wash. The kidney weight-to-recipient body weight ratio was calculated. As an indicator of graft function, we used the Modification of Diet in Renal Disease Study Group equation to estimate glomerular filtration rate. For statistical analyses, we used simple linear regression analysis and the mixed model test using SPSS version 17.0 software (SPSS, Chicago, IL, USA). Results: Mean age of recipients and median follow-up duration were 37.5 years (range, 6-77 y) and 36 months (range, 25-84 mo). Long-term graft function showed a positive correlation with kidney graft-to-recipient body weight ratio but not with the graft weight alone. The magnitude of this correlation was higher early after surgery (day 7) and decreased with long-term follow-up but was still statistically significant (P < .001). Conclusions: From our results, we conclude that kidney graft-to-recipient body weight ratio is correlated with the kidney graft function; graft size matching may be considered for kidney donor selection.

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Does Donor Nephron Mass Have Any Impact on Graft Survival?

Cited by 13 publications

References 13 publications

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Graft volume as the surrogate marker for nephron number affects the outcomes of living‐donor kidney transplantation

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