THE EFFECT OF KIDNEY SIZE ON CADAVERIC RENAL-ALLOGRAFT OUTCOME

Chronic rejection is the commonest cause of longterm renal allograft l oss. Though immunologic factors are thought dominant in its pathogenes is, nonimmunologic factors, in particular, hyperfiltration damage rela ted to reduced renal mass, have also been proposed as factors in the c ausation of chronic allograft rejection. We assessed the influence of renal size on graft survival and function in all cyclosporine-treated cadaver donor adult renal allograft recipients engrafted at a single c enter between June 1989 and July 1994, whose grafts functioned for gre ater than or equal to 3 months (n=169). Patients were divided into 4 g roups based on the ratio of kidney volume to recipient body surface ar ea (volume/BSA) (ml/m(2)), and outcome in groups compared by methods i ncluding Cox's proportional hazards and Kaplan-Meier analysis. No sign ificant differences between groups existed for serum creatinine levels , presence of significant proteinuria, or 1- and B-year graft survival . There was no correlation between volume/ BSA and either serum creati nine or degree of proteinuria at 3, 6, 12, 36, and 60 months posttrans plant. Volume/BSA was similar in patients with good or poor renal func tion (58+/-21 vs. 56+/-28 ml/m(2)), with or without significant protei nuria (57+/-24 vs. 60+/-25 ml/m(2)), or in patients who lost their gra fts to chronic rejection compared with those with stable allograft fun ction (64+/-34 vs. 59+/-24 ml/m(2)). Volume/BSA was not a predictor of graft survival on multivariate regression. We conclude that donor kid ney size has no apparent effect on cadaveric renal allograft outcome i n the short and intermediate-term, suggesting that close matching of d onor kidney size to recipient size is not presently indicated.