Donor and Recipient Size Mismatch in Pediatric Living Donor Renal Transplantation Affects Long-Term Graft Survival

Abstract

Introduction: Controversies in donor and recipient size mismatch in the adult renal transplant literature exist regarding the use of kidneys from small donors into larger recipients. However, insufficient information is known regarding this issue in pediatric renal transplantation. Methods: We reviewed the United Network for Organ Sharing STAR files from 1987 through 2010 for all pediatric patients (0-18 years old) who underwent primary living donor kidney transplant. According to donor/recipient body surface area (BSA) ratio, patients were stratified into 2 categories: BSA ratio < 0.9 and BSA ratio ≥ 0.9. Graft survival rates were compared between these two groups using Kaplan-Meier survival curves and cox proportional hazards models. Results: Of the 3021 patients identified, 112 (3%) had a BSA ratio of < 0.9 and 3089 (97%) had a BSA ratio of ≥0.9. BSA ratio of < 0.9 conferred an increased risk of graft loss (adjusted hazard ratio [HR] 2.40, 95% CI 1.74, 3.33, p< 0.001. Patients with a BSA ratio ≥0.9 group had a significantly greater graft survival compared to those in the group with a BSA < 0.9 (figure 1) after adjustment for: donor age and gender, recipient age, gender ethnicity, cause of renal failure as well as clinical factors: cold and warm ischemia time and HLA mismatch.[Figure 1. Long-term Graft Survival]Conclusion: We conclude that low body surface area ratio strongly correlates with an increased risk of graft loss and size appropriate matching confers better long-term graft survival in pediatric living donor renal transplantation.