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New Clinical Marker of Allograft Success: Size Matters in Renal Allograft Survival

New Clinical Marker of Allograft Success: Size Matters in Renal Allograft Survival. Reference: Shapiro R. Size matters in renal allograft survival. J Am Soc Nephrol. 2010;21:891. A number of nephrons representing renal fate and function are of clinical importance.

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New Clinical Marker of Allograft Success: Size Matters in Renal Allograft Survival

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  1. New Clinical Marker of Allograft Success: Size Matters in Renal Allograft Survival Reference: Shapiro R. Size matters in renal allograft survival. J Am Soc Nephrol. 2010;21:891.

  2. A number of nephrons representing renal fate and function are of clinical importance. • People with enough number of nephrons get through life with a lower risk for cardiovascular and chronic kidney disease. • When it comes to selecting a donor for renal transplantation, the size of the allograft holds the concern. • An interesting and confrontational article published in the Journal of the American Society of Nephrology illustrated a new clinical marker of allograft success: The ratio of the weight of the renal allograft before implantation to the recipient weight (Kw/Rw; g/kg).

  3. The authors noted that recipients with a Kw/Rw of <2.3 g/kg experience worse long-term graft survival, worse long-term graft function as measured by the glomerularfiltration rate, more proteinuria, more hypertension and more glomerulosclerosis than recipients of a kidney with a Kw/Rw of >2.3 g/kg. • In addition, occurrence of acute rejection also had a more detrimental effect in patients with a low Kw/Rw. • The risk of kidney deterioration in patients with Kw/Rw of <2.3 g/kg was found to arise beyond 7 years after transplantation. • This was confirmed from trials, which were conducted involving more than 1,000 adult patients, almost all deceased-donor kidney recipients. • It was noted that lower ratios of Kw/Rw occurred more in female donors and male recipients.

  4. Thus, the effect of Kw/Rw represents a new and welldesigned way of quantifying the potentially negative effect of nephronunderdosing. • In addition, it conveys that this effect occurs after a long time of transplantation. • Most study outcomes of post kidney transplantation experience challenges like insufficient follow-up. In fact, the authors’ previous publication also evidenced no impact of Kw/Rw on 3-year outcomes. • It can be considered, whether the current observation would hold true in recipients who are not on long-term calcineurin inhibitors. If calcineurin inhibitor-sparing or other avoidance regimens are used in an increasing percentage of patients, it will be interesting to see whether these observations on weight ratios remain relevant. • In conclusion, it will be important to reproduce these challenging observations in large group of patients with a long follow-up.

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