Impact  of  Donor  and  Recipient  BMI  Incompatibility  on   Graft  Function  after  Kidney  Transplantation

  • Author / Creator
    Morgan, Catherine
  •   Renal   transplant   is   the   treatment   of   choice   for   people   with   end   stage   renal   disease   (ESRD)   and   long   term   survival,   quality   of   life,   and   healthcare   utilization   after   kidney  transplantation  is  critically  dependant  on  maintaining  allograft  function.    One  factor   that   may   be   an   important   predictor   of   post-­transplant   kidney   function   is   the   size   match   between  donor  and  recipient,  as  it  may  represent  the  relationship  between  donor  nephron   mass   and   recipient   demand.     There   have   been   a   number   of   studies   evaluating   this,   however  the  sum  of  the  evidence  is  inconclusive.    The  overarching  goal  of  this  project  is   to   define   the   importance   of   donor   and   recipient   body   size   matching   (specifically   body   mass  index  (BMI)  matching)  in  renal  transplant  for  graft  function.    Methods:    This  was  a   retrospective   single-­center   cohort   study,   using   an   established   renal   transplant   database   which   included   all   renal   allograft   recipients   at   the   University   of   Alberta   Hospital   who   received  a  transplant  between  January  2,  1990,  and  August  31,  2005.    Data  was  collected   at   the   time   of   transplant,   monthly   until   24   months   post-­transplant,   and   then   every   6   months   until   death,   graft   loss,   or   loss   to   follow-­up.     Data   included   donor,   recipient   and   transplantation   characteristics   previously   reported   to   predict   renal   graft   function   and/or   survival  and  with  potential  to  confound  or  modify  the  effect  of  donor  to  recipient  BMI  ratio   (D/RBMIR).     In   addition,   creatinine   was   measured   at   each   of   the   above   time   points.       Multiple   linear   regression   was   used   to   determine   the   association   between   D/RBMIR   and   estimated   glomerular   filtration   rate   (eGFR)   at   1   year,   3   years,   and   5   years   post-­ transplant,   as   well   as   annualized   change   in   GFR.     Results:     eGFR   at   1,   3,   and   5   years   after   transplant   increases   as   D/RBMIR   decreases,   however,   the   effect   of   D/RBMIR   on   eGFR   is   no   longer   statistically   significant   when   the   effect   of   recipient   BMI   is   taken   into   account.    D/RBMIR  is  not  associated  with  annualized  change  in  eGFR.    Patients  with  higher   BMI  have  higher  eGFR  at  1,  3  and  5  years  post-­transplant  and  have  slower  loss  of  eGFR   over  time,  even  after  adjusting  for  eGFR  at  1  year  post-­transplant  (which  did  not  predict   slope).    Conclusions:    In  summary,  this  project  has  demonstrated  that  recipient  BMI  is   an   important   predictor   of   graft   function   after   renal   transplantation,   and   likely   leads   to   hyperfiltration   that   can   result   in   glomerulosclerosis   and   chronic   allograft   nephropathy,   consistent   with   previously   published   data.     A   novel   finding   is   that   this   effect   is   independent  of  the  match  between  donor  and  recipient  BMI,  suggesting  that  the  latter  is   not   as   important   as   previously   suggested.     Contrary   to   popular   thought,   D/RBMIR   at   transplant  only  predicts  graft  function  when  recipient  BMI  is  not  considered.  

  • Subjects / Keywords
  • Graduation date
    Fall 2011
  • Type of Item
  • Degree
    Master  of  Science  
  • DOI
  • License
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