Matching kidneys for size in renal transplantation

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Abstract
Analyses of cadaveric renal transplants performed since 1984 show that the effective size of the donor kidney relative to the recipient is a major factor in determining graft outcome. One‐year graft survival was 78% for 13114 adult recipients of kidneys from donors aged 13 to 50 yr, but declined progressively with donor age to 54% in 276 recipients of kidneys from donors under 3 and to 61% in 230 recipients of kidneys from donors over 60. Similarly, survival of adult female but not male donor kidneys transplanted to adult recipients decreased as the recipient weight increased up to 95 kg. The optimum early graft function was excellent for 87% of recipients weighing less than 45 kg, 63% of those between 46 and 60 kg, and this proportion decreased to 25% of recipients weighing more than 95 kg. Small kidneys transplanted to large recipients may be damaged by hyperfiltration or cyclosporine toxicity in addition to the adverse effects of immunological assaults on the transplanted organ. Therefore, we recommend avoidance of radical size mismatches between donor and recipient and examination of kidneys from donors over 50 for sclerotic glomeruli to ensure that the size of the organ will be adequate for the size of the recipient.