Impact of Donated Kidney Volume and Recipient Body Surface Area Incompatibility on the Allograft Outcomes with Pre-transplant Diabetes Mellitus

Y. Park¹, H. Lee², E. Ko², C. Yang², B. Chung²

¹Internal Medicine, Konyang University Hospital, Daejeon, Korea, Republic of, ²Internal Medicine, Seoul St. Mary's Hospital, Seoul, Korea, Republic of

Meeting: 2021 American Transplant Congress

Abstract number: 1058

Keywords: Graft survival, Kidney transplantation, Synergism

Topic: Clinical Science » Kidney » Kidney Complications: Non-Immune Mediated Late Graft Failure

Session Information

Session Name: Kidney Complications: Non-Immune Mediated Late Graft Failure

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: The aim of this study was to analyze the impact on the adverse allograft outcome of transplanting relative small kidneys in patients with pre-transplant diabetes mellitus (DM).

*Methods: From January 2010 to December 2018, 1,290 KTs were performed in Seoul St Mary’s Hospital. Of these, 788 cases of non-sensitized living donor kidney transplant recipient and donor pairs were enrolled. They were divided into 4 groups (non-DM large kidney, non-DM small kidney, DM large kidney, DM small kidney) according to the size incompatibility (donated kidney volume and recipient’s body surface area ratio) and pre-transplant DM status. The primary outcome of this study was to analyze the effect of size incompatibility and pre-transplant DM status on the incidence of DCGL.

*Results: There was no significant difference in the biopsy proven acute rejection rate among the 4 groups. DM small kidney group showed significantly higher DCGL rate (17/129 (13.2%), P = 0.008) than the other groups. The combined presence of pre-transplant DM and relative small kidney was an independent risk factor for DCGL (adjusted hazard ratio 2.921, P = 0.019), and these showed significant interaction with each other (P for interaction < 0.001). Moreover, renal function after 4 years of transplantation worsened faster in the DM small kidney group compared to the other groups, and allograft survival decreased after 1 year of transplantation.

*Conclusions: Our results suggest that transplanting large kidneys rather than small kidneys is considered to have an advantage in terms of allograft outcome in pre-transplant DM patients, and this should be considered in donor selection.

Cox proportional hazard ratio model analysis for death censored graft loss
	Univariable HR (95% CI)	P-value	Multivariable HR (95% CI)	P-value	P-value for interaction
Pretransplant DM (-)	Reference
Pretransplant DM (+)	1.851 (1.057-3.243)	0.031	–	–
Relative large kidney	Reference
Relative small kidney	1.908 (1.085-3.357)	0.025	2.432 (1.160-5.099)	0.019
Pretransplant DM (+) & Relative small kidney	3.176 (1.600-6.305)	0.001	2.921 (1.193-7.155)	0.019	<0.001

To cite this abstract in AMA style:

Park Y, Lee H, Ko E, Yang C, Chung B. Impact of Donated Kidney Volume and Recipient Body Surface Area Incompatibility on the Allograft Outcomes with Pre-transplant Diabetes Mellitus [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-donated-kidney-volume-and-recipient-body-surface-area-incompatibility-on-the-allograft-outcomes-with-pre-transplant-diabetes-mellitus/. Accessed May 11, 2025.

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