RECIPIENT BODY-SIZE AND CADAVERIC RENAL-ALLOGRAFT SURVIVAL

Transplantation of renal allografts inadequate to meet recipient metab olic demands has been hypothesized to be one cause of chronic allograf t failure. This cohort study examined the relationship of each of thre e measures of recipient body size and one measure of recipient metabol ic rate to the rate of allograft failure among 239 recipients of cadav eric renal allografts between 1985 and 1990. All subjects were followe d until allograft failure, death, or December 31, 1992, whichever occu rred first. Using multivariate Cox proportional hazards analysis, all measures of recipient size and metabolic rate were found to be strong and statistically significant predictors of allograft survival adjuste d for other predictors of allograft survival including allograft rejec tion, delayed allograft function, recipient race, prior renal transpla ntation, and donor age. The adjusted relative risk (RR) of allograft f ailure for a 15-kg increase in recipient body weight was 1.47, P < 0.0 001 (95% confidence interval (CI), 1.21-1.78); adjusted RR for a 10-U increase in recipient body mass index was 2.34, P < 0.0001 (95% CI, 1. 53-3.58); adjusted RR for a 0.5 m(2) increase in recipient body surfac e area was 2.34, P < 0.001 (95% CI, 1.40-3.91); and adjusted RR for a 250 Kcal increase in metabolic rate was 1.49, P < 0.01 (95% CI, 1.17-1 .89). These results are consistent with prior research indicating that a renal tissue supply-demand mismatch may accelerate failure of renal allografts. Alternative explanations of this relationship between rec ipient body size and allograft survival include inadequate immunosuppr essive medication administration among recipients with a larger body s ize. Additional research is warranted to examine more fully the relati onship between recipient body size and allograft survival.