TY - JOUR
T1 - Quantifying donor effects on transplant outcomes using kidney pairs from deceased donors
AU - Kerr, Kathleen F.
AU - Morenz, Eric R.
AU - Thiessen-Philbrook, Heather
AU - Coca, Steven G.
AU - Wilson, F. Perry
AU - Reese, Peter P.
AU - Parikh, Chirag R.
N1 - Funding Information:
Dr. Coca is supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grants (R01-DK115562 and U01DK106962). Dr. Kerr is supported by a National Institutes of Health subcontract from Johns Hopkins University to University of Washington. Dr. Parikh is supported by National Heart, Lung, and Blood Institute and NIDDK grant (R01-DK 093770). Dr. Wilson is supported by NIDDK grants (R01-DK 113191 and U01DK079210).
Publisher Copyright:
© 2019 by the American Society of Nephrology.
PY - 2019/12/6
Y1 - 2019/12/6
N2 - Background and objectives In kidney transplantation, the relative contribution of donor versus other factors on clinical outcomes is unknown. We sought to quantify overall donor effects on transplant outcomes for kidney donations from deceased donors. Design, setting, participants, & measurements For paired donations from deceased donors resulting in transplants to different recipients, the magnitude of donor effects can be quantified by examining the excess of concordant outcomes within kidney pairs beyond chance concordance. Using data from the Organ Procurement and Transplantation Network between the years 2013 and 2017, we examined concordance measures for delayed graft function, death-censored 1-year graft failure, and death-censored 3-year graft failure. The concordance measures were excess relative risk, excess absolute risk, and the fixation index (where zero is no concordance and one is perfect concordance). We further examined concordance in strata of kidneys with similar values of the Kidney Donor Profile Index, a common metric of organ quality. Results If the transplant of the kidney mate resulted in delayed graft function, risk for delayed graft function was 19% higher (95% confidence interval [95% CI], 18% to 20%), or 1.76-fold higher (95% CI, 1.73-to 1.80-fold), than baseline. If a kidney graft failed within 1 year, then the kidney mate’s risk of failure was 6% higher (95% CI, 4% to 9%), or 2.85-fold higher (95% CI, 2.25-to 3.48-fold), than baseline. For 3-year graft failure, the excess absolute risk was 7% (95% CI, 4% to 10%) but excess relative risk was smaller, 1.91-fold (95% CI, 1.56-to 2.28-fold). Fixation indices were 0.25 for delayed graft function (95% CI, 0.24 to 0.27), 0.07 for 1-year graft failure (95% CI, 0.04 to 0.09), and 0.07 for 3-year graft failure (95% CI, 0.04 to 0.10). Results were similar in strata of kidneys with a similar Kidney Donor Profile Index. Conclusions Overall results indicated that the donor constitution has small or moderate effect on post-transplant clinical outcomes.
AB - Background and objectives In kidney transplantation, the relative contribution of donor versus other factors on clinical outcomes is unknown. We sought to quantify overall donor effects on transplant outcomes for kidney donations from deceased donors. Design, setting, participants, & measurements For paired donations from deceased donors resulting in transplants to different recipients, the magnitude of donor effects can be quantified by examining the excess of concordant outcomes within kidney pairs beyond chance concordance. Using data from the Organ Procurement and Transplantation Network between the years 2013 and 2017, we examined concordance measures for delayed graft function, death-censored 1-year graft failure, and death-censored 3-year graft failure. The concordance measures were excess relative risk, excess absolute risk, and the fixation index (where zero is no concordance and one is perfect concordance). We further examined concordance in strata of kidneys with similar values of the Kidney Donor Profile Index, a common metric of organ quality. Results If the transplant of the kidney mate resulted in delayed graft function, risk for delayed graft function was 19% higher (95% confidence interval [95% CI], 18% to 20%), or 1.76-fold higher (95% CI, 1.73-to 1.80-fold), than baseline. If a kidney graft failed within 1 year, then the kidney mate’s risk of failure was 6% higher (95% CI, 4% to 9%), or 2.85-fold higher (95% CI, 2.25-to 3.48-fold), than baseline. For 3-year graft failure, the excess absolute risk was 7% (95% CI, 4% to 10%) but excess relative risk was smaller, 1.91-fold (95% CI, 1.56-to 2.28-fold). Fixation indices were 0.25 for delayed graft function (95% CI, 0.24 to 0.27), 0.07 for 1-year graft failure (95% CI, 0.04 to 0.09), and 0.07 for 3-year graft failure (95% CI, 0.04 to 0.10). Results were similar in strata of kidneys with a similar Kidney Donor Profile Index. Conclusions Overall results indicated that the donor constitution has small or moderate effect on post-transplant clinical outcomes.
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U2 - 10.2215/CJN.03810319
DO - 10.2215/CJN.03810319
M3 - Article
C2 - 31676539
AN - SCOPUS:85076329709
SN - 1555-9041
VL - 14
SP - 1781
EP - 1787
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 12
ER -