The effect of donor/recipient body surface area ratio on the selection of potential recipient after DCD renal transplantation

Abstract

Objective To evaluate the effect of donor/recipient(D/R)body surface area(BSA)ratio on the recovery of renal transplantation from donation after cardiac death(DCD) and guidance of potential recipients. Methods The clinical data of 127 recipients with the functioned graft and 69 donors of DCD kidney transplantation performed in our hospital from July 2012 to March 2015 were retrospectively analyzed.69 donors contained 58 males and 11 females, with the mean age of (41.9±13.5) years(ranged from 18 to 66 years) and the mean BSA of (1.77±0.15) m2(ranged from 1.25 to 2.05 m2); 127 recipients contained 100 males and 27 females, with the mean age of (37.7±9.3) years(ranged from 18 to 58 years) and the mean BSA of (1.70±0.16) m2(ranged from 1.34 to 2.21 m2). According to D/R BSA ratio, recipients were divided into D/R BSA ratio≤1.0 group(39 recipients)and D/R BSA ratio>1.0 group(88 recipients). According to donor eGFR, recipients were divided into four subgroups further: Group A [D/R BSA ratio≤1.0 group, eGFR≤40 ml/(min·1.73 m2)]with 5 recipients, group B [D/R BSA ratio ≤1.0, eGFR >40 ml/(min·1.73 m2)]with 34 recipients, group C[D/R BSA ratio> 1.0 group, eGFR≤40 ml/(min·1.73 m2)]with 16 recipients, Group D[D/R BSA ratio> 1.0 group, eGFR> 40 ml/(min·1.73 m2)]with 72 recipients; In addition, two recipients who received the kidneys from the same donor and whose D/R BSA ratio difference was more than 10% were divided into high BSA ratio group (27 recipients)and low BSA ratio group(27 recipients). The serum creatinine(SCr) and graft eGFR of the recipients were recorded at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 12 months post-operation respectively. Results Recipients in D/R BSA ratio>1.0 group showed lower SCr and higher graft eGFR at each time point post-transplantation as compared to D/R BSA ratio≤1.0 group, and the difference was statistically significant (P 0.05); Recipients in high BSA ratio group showed slightly lower SCr as compared to low BSA ratio group within 3 months post-operation, but the difference was not statistically significant (P>0.05); 3 months later, Scr in high BSA ratio group was lower than low BSA ratio group, and the difference was statistically significant (P 0.05); 1 month later, eGFR in high BSA ratio group was higher than low BSA ratio group, and the difference was statistically significant (P<0.05). Conclusions D/R BSA ratio should be used as an important reference index to choose potential recipients. To potential marginal donors with older age or inferior renal function, the recovery of renal function after operation is relatively better when the D/R BSA ratio is higher than 1.0. When kidneys of the same donor are accepted, recipients with higher D/R BSA ratio show a more ideal long-term recovery of renal function and achieve a better postoperative effect. Key words: Donation after citizen death; Body surface area; Renal transplantation