TY - JOUR
T1 - Outcomes From Right Versus Left Deceased-Donor Kidney Transplants
T2 - A US National Cohort Study
AU - Kulkarni, Sanjay
AU - Wei, Guo
AU - Jiang, Wei
AU - Lopez, Licia A.
AU - Parikh, Chirag R.
AU - Hall, Isaac E.
N1 - Funding Information:
Sanjay Kulkarni, MD, Guo Wei, MS, Wei Jiang, MS, Licia A. Lopez, BS, Chirag R. Parikh, MD, PhD, and Isaac E. Hall, MD, MS. Research idea and study design: IEH; statistical analysis: WJ, GW; data analysis/interpretation: SK, CRP, IEH; literature review: LAL, IEH; supervision or mentorship: CRP, IEH. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. This work was funded in part by the Health Resources and Services Administration contract 234-2005-37011C and grants awarded to Dr Hall from the American Heart Association (12FTF12080082) and the National Institutes of Health/National Center for Advancing Translational Sciences (UL1TR002538 and KL2TR002539). The funders did not have a role in study design; data collection, analysis, or reporting; or the decision to submit for publication. The authors declare that they have no relevant financial interests. The data reported here have been supplied by UNOS as the contractor for the OPTN. The interpretation and reporting of these data in no way should be seen as an official policy of or interpretation by the OPTN or the US government. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government. These organizations were not involved in study design, analysis, interpretation, or manuscript creation. Received February 17, 2019. Evaluated by 2 external peer reviewers, with direct editorial input from a Statistics/Methods Editor and an Associate Editor, who served as Acting Editor-in-Chief. Accepted in revised form August 10, 2019. The involvement of an Acting Editor-in-Chief was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies.
Funding Information:
This work was funded in part by the Health Resources and Services Administration contract 234-2005-37011C and grants awarded to Dr Hall from the American Heart Association ( 12FTF12080082 ) and the National Institutes of Health / National Center for Advancing Translational Sciences ( UL1TR002538 and KL2TR002539 ). The funders did not have a role in study design; data collection, analysis, or reporting; or the decision to submit for publication.
Publisher Copyright:
© 2019 National Kidney Foundation, Inc.
PY - 2020/5
Y1 - 2020/5
N2 - Rationale & Objective: There may be important transplant-related differences between right and left kidneys, including logistical/surgical considerations about vessel length for the right compared to the left kidney from the same donor. Because US centers choose between the right and left kidney when their recipient is ranked higher on a “match-run,” we sought to determine whether deceased-donor right kidneys have had worse posttransplantation outcomes than left kidneys. Study Design: Paired Organ Procurement and Transplantation Network analysis. Setting & Participants: Deceased-donor kidney pairs transplanted during 1990 to 2016. Exposure: Right versus left kidney controlling for other significant factors. Outcomes: Delayed graft function (DGF), all-cause and death-censored graft failure, and mortality. Analytical Approach: Multivariable conditional logistic regression for DGF; proportional hazards models (conditional on same donor) for failure/mortality with right kidneys (operationalized as 6-month time-varying coefficients) adjusting for DGF and other confounders. Results: 87,112 recipient pairs shared the following donor characteristics: mean age of 41 ± 14 years, 60% males, and 11% with cardiac death. Recipient characteristics were numerically similar by donor kidney side but with some statistical differences given the sample size. Right kidneys had slightly longer cold ischemia time. DGF occurred more often for right kidneys (28% vs 25.8%; P < 0.001; adjusted OR, 1.15 [95% CI, 1.12-1.17]). The adjusted hazard ratio (aHR) for all-cause graft failure with right kidneys within 6 months was 1.07 (95% CI, 1.03-1.11), and was 0.99 (95% CI, 0.97-1.01) thereafter. The aHRs for death-censored graft failure with right kidneys before and after 6 months were 1.11 (95% CI, 1.06-1.16) and 0.96 (95% CI, 0.93-0.99), respectively; the corresonding aHRs for mortality were 0.99 (95% CI, 0.93-1.04) and 1.00 (95% CI, 0.98-1.03), respectively. Limitations: Registry data, different transplant eras, reasons for kidney side unavailable. Conclusions: There is modest association for transplantation of right kidneys with DGF and graft loss within the first 6 months, which is lost beyond this time point. These findings do not support the use of laterality of deceased-donor kidneys as an important factor in organ acceptance decisions.
AB - Rationale & Objective: There may be important transplant-related differences between right and left kidneys, including logistical/surgical considerations about vessel length for the right compared to the left kidney from the same donor. Because US centers choose between the right and left kidney when their recipient is ranked higher on a “match-run,” we sought to determine whether deceased-donor right kidneys have had worse posttransplantation outcomes than left kidneys. Study Design: Paired Organ Procurement and Transplantation Network analysis. Setting & Participants: Deceased-donor kidney pairs transplanted during 1990 to 2016. Exposure: Right versus left kidney controlling for other significant factors. Outcomes: Delayed graft function (DGF), all-cause and death-censored graft failure, and mortality. Analytical Approach: Multivariable conditional logistic regression for DGF; proportional hazards models (conditional on same donor) for failure/mortality with right kidneys (operationalized as 6-month time-varying coefficients) adjusting for DGF and other confounders. Results: 87,112 recipient pairs shared the following donor characteristics: mean age of 41 ± 14 years, 60% males, and 11% with cardiac death. Recipient characteristics were numerically similar by donor kidney side but with some statistical differences given the sample size. Right kidneys had slightly longer cold ischemia time. DGF occurred more often for right kidneys (28% vs 25.8%; P < 0.001; adjusted OR, 1.15 [95% CI, 1.12-1.17]). The adjusted hazard ratio (aHR) for all-cause graft failure with right kidneys within 6 months was 1.07 (95% CI, 1.03-1.11), and was 0.99 (95% CI, 0.97-1.01) thereafter. The aHRs for death-censored graft failure with right kidneys before and after 6 months were 1.11 (95% CI, 1.06-1.16) and 0.96 (95% CI, 0.93-0.99), respectively; the corresonding aHRs for mortality were 0.99 (95% CI, 0.93-1.04) and 1.00 (95% CI, 0.98-1.03), respectively. Limitations: Registry data, different transplant eras, reasons for kidney side unavailable. Conclusions: There is modest association for transplantation of right kidneys with DGF and graft loss within the first 6 months, which is lost beyond this time point. These findings do not support the use of laterality of deceased-donor kidneys as an important factor in organ acceptance decisions.
KW - Kidney transplantation
KW - deceased organ donor
KW - delayed graft function (DGF)
KW - end-stage renal disease (ESRD)
KW - graft survival
KW - kidney laterality
KW - matched-pair analysis
KW - organ acceptance
KW - right versus left
KW - transplant outcomes
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U2 - 10.1053/j.ajkd.2019.08.018
DO - 10.1053/j.ajkd.2019.08.018
M3 - Article
C2 - 31812448
AN - SCOPUS:85076235262
SN - 0272-6386
VL - 75
SP - 725
EP - 735
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -