Clinical and pathological features of donor/recipient body weight mismatch after kidney transplantation

Takafumi Yamakawa; Akimitsu Kobayashi; Izumi Yamamoto; Yasuyuki Nakada; Aki Mafune; Haruki Katsumata; Maiko Furuya; Kentaro Koike; Jun Miki; Hiroki Yamada; Yudo Tanno; Ichiro Ohkido; Nobuo Tsuboi; Keitaro Yokoyama; Hiroyasu Yamamoto; Takashi Yokoo

doi:10.1111/nep.12470

Clinical and pathological features of donor/recipient body weight mismatch after kidney transplantation

Nephrology (Carlton). 2015 Jul:20 Suppl 2:36-9. doi: 10.1111/nep.12470.

Authors

Takafumi Yamakawa¹, Akimitsu Kobayashi^{1

2}, Izumi Yamamoto¹, Yasuyuki Nakada¹, Aki Mafune¹, Haruki Katsumata¹, Maiko Furuya¹, Kentaro Koike¹, Jun Miki³, Hiroki Yamada³, Yudo Tanno¹, Ichiro Ohkido¹, Nobuo Tsuboi¹, Keitaro Yokoyama¹, Hiroyasu Yamamoto², Takashi Yokoo¹

Affiliations

¹ Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
² Department of Internal Medicine, Atsugi City Hospital, Kanagawa, Japan.
³ Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.

PMID: 26031584
DOI: 10.1111/nep.12470

Abstract

Background: Previous studies have shown that a donor/recipient body weight mismatch affects long-term graft survival and graft function after kidney transplantation. However, the mechanisms are not fully understood.

Aim: To address the mechanisms, we compared the pathological and physiological features between patients with a donor/recipient body weight mismatch and those without a mismatch 1 yr after kidney transplantation. Furthermore, we investigated the correlation with the donor/recipient body weight ratio.

Methods: We examined allograft biopsy specimens from 10 recipients with stable kidney function, with body weight mismatch (donor/recipient body weight ratio [D/R BWR] < 0.9), and compared them with samples from 13 patients without mismatch. We measured glomerular volume (GV) using the Weibel-Gomez method and glomerular density (GD) defined by nonsclerotic glomerular number/renal cortical area as pathological findings. The physiological parameters included estimated glomerular filtration rate and proteinuria (mg/day). These data were evaluated to identify a correlation with D/R BWR.

Results: The pathological features showed that GV and GD were identical in the two groups. However, when glomerular enlargement was defined by ΔGV (GV at the 1-yr biopsy minus GV at baseline biopsy), ΔGV was higher in mismatch cases compared with that in cases without a mismatch (10.6 ± 4.6 vs. 5.5 ± 7.1 × 10(5) μm(3) ; P = 0.049). Furthermore, D/R BWR was significantly correlated with ΔGV (P = 0.03, r = -0.436). eGFR values were physiologically identical between the two groups, but the mismatch cases had significantly higher proteinuria levels than that of the cases without a mismatch at 1 yr after kidney transplantation.

Conclusion: A donor/recipient body weight mismatch could affect glomerular enlargement and increased proteinuria 1 yr after kidney transplantation. How these two features affect long-term graft survival and function must be addressed in the future.

Keywords: body weight mismatch; glomerular enlargement; kidney transplantation.

MeSH terms

Allografts
Biopsy
Body Weight*
Donor Selection*
Female
Glomerular Filtration Rate
Graft Survival
Humans
Kidney Glomerulus / pathology*
Kidney Glomerulus / physiopathology
Kidney Glomerulus / transplantation*
Kidney Transplantation* / adverse effects
Male
Middle Aged
Organ Size
Predictive Value of Tests
Proteinuria / etiology
Risk Factors
Time Factors
Tissue Donors*
Treatment Outcome