TY - JOUR
T1 - Better graft outcomes from offspring donor kidneys among living donor kidney transplant recipients in the United States
AU - Holscher, Courtenay M.
AU - Luo, Xun
AU - Massie, Allan B
AU - Purnell, Tanjala S.
AU - Garonzik, Jacqueline
AU - Bae, Sunjae
AU - Henderson, Macey
AU - Al Ammary, Fawaz
AU - Ottmann, Shane
AU - Segev, Dorry L.
N1 - Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2019/1
Y1 - 2019/1
N2 - A recent study reported that kidney transplant recipients of offspring living donors had higher graft loss and mortality. This seemed counterintuitive, given the excellent HLA matching and younger age of offspring donors; we were concerned about residual confounding and other study design issues. We used Scientific Registry of Transplant Recipients data 2001-2016 to evaluate death-censored graft failure (DCGF) and mortality for recipients of offspring versus nonoffspring living donor kidneys, using Cox regression models with interaction terms. Recipients of offspring kidneys had lower DCGF than recipients of nonoffspring kidneys (15-year cumulative incidence 21.2% vs 26.1%, P <.001). This association remained after adjustment for recipient and transplant factors (adjusted hazard ratio [aHR] = 0.73 0.77 0.82 , P <.001), and was attenuated among African American donors (aHR 0.77 0.85 0.95 ; interaction: P =.01) and female recipients (aHR 0.77 0.84 0.91 , P <.001). Although offspring kidney recipients had higher mortality (15-year mortality 56.4% vs 37.2%, P <.001), this largely disappeared with adjustment for recipient age alone (aHR = 1.02 1.06 1.10 , P =.002) and was nonsignificant after further adjustment for other recipient characteristics (aHR = 0.93 0.97 1.01 , P =.1). Kidneys from offspring donors provided lower graft failure and comparable mortality. An otherwise eligible donor should not be dismissed because they are the offspring of the recipient, and we encourage continued individualized counseling for potential donors.
AB - A recent study reported that kidney transplant recipients of offspring living donors had higher graft loss and mortality. This seemed counterintuitive, given the excellent HLA matching and younger age of offspring donors; we were concerned about residual confounding and other study design issues. We used Scientific Registry of Transplant Recipients data 2001-2016 to evaluate death-censored graft failure (DCGF) and mortality for recipients of offspring versus nonoffspring living donor kidneys, using Cox regression models with interaction terms. Recipients of offspring kidneys had lower DCGF than recipients of nonoffspring kidneys (15-year cumulative incidence 21.2% vs 26.1%, P <.001). This association remained after adjustment for recipient and transplant factors (adjusted hazard ratio [aHR] = 0.73 0.77 0.82 , P <.001), and was attenuated among African American donors (aHR 0.77 0.85 0.95 ; interaction: P =.01) and female recipients (aHR 0.77 0.84 0.91 , P <.001). Although offspring kidney recipients had higher mortality (15-year mortality 56.4% vs 37.2%, P <.001), this largely disappeared with adjustment for recipient age alone (aHR = 1.02 1.06 1.10 , P =.002) and was nonsignificant after further adjustment for other recipient characteristics (aHR = 0.93 0.97 1.01 , P =.1). Kidneys from offspring donors provided lower graft failure and comparable mortality. An otherwise eligible donor should not be dismissed because they are the offspring of the recipient, and we encourage continued individualized counseling for potential donors.
KW - donors and donation: living
KW - ethnicity/race
KW - graft survival
KW - health services and outcomes research
KW - kidney transplantation/nephrology
KW - kidney transplantation: living donor
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U2 - 10.1111/ajt.15126
DO - 10.1111/ajt.15126
M3 - Article
C2 - 30253051
AN - SCOPUS:85055108902
SN - 1600-6135
VL - 19
SP - 269
EP - 276
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 1
ER -