Faculty Collaboration Database

Patient and Kidney Allograft Survival with National Kidney Paired Donation. Clin J Am Soc Nephrol 2020 Feb 07;15(2):228-237

Date

01/30/2020

Pubmed ID

31992572

Pubmed Central ID

PMC7015097

DOI

10.2215/CJN.06660619

Scopus ID

2-s2.0-85079154253 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

BACKGROUND AND OBJECTIVES: In the United States, kidney paired donation networks have facilitated an increasing proportion of kidney transplants annually, but transplant outcome differences beyond 5 years between paired donation and other living donor kidney transplant recipients have not been well described.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using registry-linked data, we compared National Kidney Registry (n=2363) recipients to control kidney transplant recipients (n=54,497) (February 2008 to December 2017). We estimated the risk of death-censored graft failure and mortality using inverse probability of treatment weighted Cox regression. The parsimonious model adjusted for recipient factors (age, sex, black, race, body mass index ≥30 kg/m², diabetes, previous transplant, preemptive transplant, public insurance, hepatitis C, eGFR, antibody depleting induction therapy, year of transplant), donor factors (age, sex, Hispanic ethnicity, body mass index ≥30 kg/m²), and transplant factors (zero HLA mismatch).

RESULTS: National Kidney Registry recipients were more likely to be women, black, older, on public insurance, have panel reactive antibodies >80%, spend longer on dialysis, and be previous transplant recipients. National Kidney Registry recipients were followed for a median 3.7 years (interquartile range, 2.1-5.6; maximum 10.9 years). National Kidney Registry recipients had similar graft failure (5% versus 6%; log-rank P=0.2) and mortality (9% versus 10%; log-rank P=0.4) incidence compared with controls during follow-up. After adjustment for donor, recipient, and transplant factors, there no detectable difference in graft failure (adjusted hazard ratio, 0.95; 95% confidence interval, 0.77 to 1.18; P=0.6) or mortality (adjusted hazard ratio, 0.86; 95% confidence interval, 0.70 to 1.07; P=0.2) between National Kidney Registry and control recipients.

CONCLUSIONS: Even after transplanting patients with greater risk factors for worse post-transplant outcomes, nationalized paired donation results in equivalent outcomes when compared with control living donor kidney transplant recipients.

Author List

Leeser DB, Thomas AG, Shaffer AA, Veale JL, Massie AB, Cooper M, Kapur S, Turgeon N, Segev DL, Waterman AD, Flechner SM

Author

Matthew Cooper MD Chief, Director, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Case-Control Studies
Donor Selection
Female
Graft Survival
Humans
Kidney Transplantation
Living Donors
Male
Middle Aged
Registries
Risk Assessment
Risk Factors
Time Factors
Tissue and Organ Procurement
Treatment Outcome
United States