Metabolic Demand and Nephron Supply on Early Graft Function after Living Donor Kidney Transplantation

Lee, Byung Mo; Oh, Chang Kwon; Kim, Ji Hye; Jeon, Kyung Ock; Kim, Hyun Jung; Kim, Soon Il; Kim, Yu Seun

Abstract

PURPOSE
Renal allograft mass may potentially affect long term outcome after kidney transplantation. An inadequate renal mass to metabolic demand might trigger hyperfiltration and consequently contribute to the progression of graft nephropathy and failure.
METHODS
This is a prospective study with 195 cases of 2 transplant centers. The study population was restricted to live donor transplants except the cases of diabetes, ischemic injury, rejection, and any complication which might result in functional decrease of the kidney graft. Recipient's serum creatinine, 24 hours proteinuria, urine creatinine excretion and creatinine clearance were measured and calculated. Weight of donated kidney, weights and heights of both donors and recipients were recorded and the BSA, LBW, and BMI were calculated. The correlations between each variables were analyzed using Pearson's test, and P<.05 was considered significant. Significantly correlated pairs of variables were included into the linear regression for multivariate test.
RESULTS
The amount of urinary excretion of protein is associated with renal mass supply rather than functional demand of recipient. The serum creatinine is associated with the functional balance between the metabolic demand of recipient and renal mass supply from donor. The amount of urinary excretion of creatinine is associated with metabolic demand of recipient rather than renal mass supply.
CONCLUSION
Our findings provide direct evidence of a substantial effect of the balance between nephron supply and recipient metabolic demand on early graft function. We suggest that during donor-recipient matching, both the potential sizes of donated kidney and recipient should be considered in terms of early graft function.