Background: We wanted to assess the impact of donor size and donor to recipient size mismatch on kidney allograft function following living donor kidney transplant.

Methods: Retrospective, we included living donor kidney transplants between July2003 and November 2011 excluding repeat or multiorgan transplants, those with positive crossmatch or presence of DSA, or those with early graft loss or death with functioning graft. GFR at one year was estimated with the CKD epi formula and a value< 40 ml/min considered low.

Results: 579 donor-recipient pairs were included in the analysis and GFR was estimated at one year post transplant. Female donor, lower donor BSA, older donor age, biopsy proven rejection, and lower donor GFR were associated with recipient GFR<40 ml/min at one year. Donor BSA<1.7 m2 was associated with 1 yr recipient GFR<40 ml/min in 19% of patient compared to only 8% in those with donors >1.7 m2.

All except donor gender remained significant on multivariate analysis. Recipient age and BSA, ratio of recipient to donor BSA, induction and maintenance immunosuppression, number of HLA mismatches, CMV mismatch status, BK virus infection, preemptive status and donor and recipients race, all were not associated with lower recipient GFR at one year.

Conclusion: Smaller donor size, older donors, and lower donor estimated GFR independently associated with lower GFR at one year post living donor kidney transplant and should be considered when benefit outweigh the risk like in the highly sensitized recipient.

« Back to 2013 American Transplant Congress