Does graft mass impact on pediatric kidney transplant outcomes?

Does graft mass impact on pediatric kidney transplant outcomes?

Author Feltran, Luciana de Santis Autor UNIFESP Google Scholar
Nogueira, Paulo Cesar Koch Autor UNIFESP Google Scholar
Ajzen, Sergio Aron Autor UNIFESP Google Scholar
Yuji Verrastro, Carlos Gustavo Autor UNIFESP Google Scholar
Pacheco-Silva, Alvaro Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Hosp Rim & Hipertensao
Abstract The aim of this study is to assess the evolution of renal size and function in pediatric transplant patients according to the graft mass/recipient size ratio.Fifty pediatric renal transplant recipients were followed over 2 years. Grafts were weighed, and three different graft mass/m(2) ratios were determined: (1) low graft mass (58 g/m(2), range 31-57 g/m(2)), (2) median (142 g/m(2), range 59-141 g/m(2)) and high (267 g/m(2), range 143-353 g/m(2)). Patients underwent repeated ultrasound Doppler scans and repeated measurements of estimated glomerular filtration rate (eGFR; 1 week and 1, 6, 12 and 24 months), urinary retinol-binding protein (RBP) and proteinuria (1 week and 6, 12 and 24 months).The volume of renal tissue increased by 12 +/- 5.6 cm(3) at 24 months (p = 0.035) in the low graft mass and decreased by -14 +/- 7 cm(3) (p = 0.046) in the high graft mass. the eGFR increased when either low (30 +/- 5 ml/min/1.73 m(2), p < 0.001) or median (19 +/- 4 ml/min/1.73 m(2), p < 0.001) graft mass was transplanted but remained stable when high graft mass was transplanted. the resistive index (RI) presented a significant decrease throughout early follow-up in the transplants involving low and median graft mass, whereas a slight rise was observed in those involving high graft mass. A significant difference was apparent 6 months post-transplant. Transplants of low and median graft mass were associated with an initial higher urinary RBP. No significant differences in proteinuria were detected.Small kidneys undergo increases in volume and function without escalation of either proteinuria or urinary RBP, characterizing an adequate adaptation to the recipient. Children receiving larger kidneys present a reduction in volume, stable GFR and higher RI at 6 months.
Keywords Kidney transplantation
Child
Ultrasonography
Growth
Resistive index
Language English
Sponsor Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
Grant number CNPq: 1418781/2005-3
Date 2014-02-01
Published in Pediatric Nephrology. New York: Springer, v. 29, n. 2, p. 297-304, 2014.
ISSN 0931-041X (Sherpa/Romeo, impact factor)
Publisher Springer
Extent 297-304
Origin http://dx.doi.org/10.1007/s00467-013-2637-y
Access rights Closed access
Type Article
Web of Science ID WOS:000329319500017
URI http://repositorio.unifesp.br/handle/11600/37359

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