Nephrol Dial Transplant (2004) 19: III21-III25
Nephrol Dial Transplant Vol. 19 Suppl 3 © ERA–EDTA 2004; all rights reserved
A disproportionately greater body weight of the recipient in regards to the donor causes chronic graft nephropathy. A study of paired kidneys
1 Hospital 12 de Octubre, Servicio de Nefrología, Av de Córdoba s/n, 28041 Madrid, Spain and 2 Hospital Puerta del Mar, Servicio de Nefrología, Av Ana de Viya 21, 11009 Cádiz, Spain
Correspondence to and offprint requests to: Amado Andres, Hospital 12 de Octubre, Servicio de Nefrología, Av de Córdoba s/n, 28041 Madrid, Spain. Email: aandres.hdoc{at}salud.madrid.org
Abstract
Background. Chronic graft nephropathy is the most frequent cause of long-term renal transplant loss. Although immunological causes participate in its pathogenesis, other non-immunological factors such as hyperfiltration due to reduced renal mass have been proposed as causal factors of chronic renal graft nephropathy.
Aim. This study aimed to assess the effect of weight disproportion between the donor and recipient in the development of chronic renal graft nephropathy.
Methods. Three weight categories for donors and recipients were established: < 50, 50–75 and > 75 kg. Three groups were distinguished according to the three possible weight combinations between donor and recipient: donor weight (DW)>recipient weight (RW) (N = 133), DW = RW (N = 255) and DW<RW (N = 80). For the study of paired kidneys from the same donor, a multiple Cox regression model was applied to observe the influence of the weight differences between donor and recipient and other variables on the long-term graft and patient survival, and on the level of serum creatinine, proteinuria and arterial hypertension at 3 months after transplantation.
Results. Graft survival at 10 years was significantly lower in the DW<RW group vs the DW = RW and DW>RW groups. In addition, the DW<RW group developed higher proteinuria even by 3 months of evolution. Donor and recipient age, acute rejection and type of immunosuppressive treatment were also independent risk factors to develop chronic nephropathy in this study of paired kidneys.
Conclusions. Weight disproportion between donor and recipient, unfavourable to the recipient, is a risk factor for the development of chronic graft nephropathy. Matching the body weights between the donor and recipient is obligatory to prevent chronic rejection.
Keywords: chronic nephropathy; donor weight; hyperfiltration; recipient weight; renal transplantation