Inferior long-term allograft and patient outcomes among recipients of offspring living donor kidneys

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Abstract

<p class="first" id="P1">While offspring-to-parent living donor kidney transplantations may represent an ideal donor-recipient combination to optimize long-term transplant outcomes, the gender-specific long-term success of these transplants remains unclear. We hypothesize that allograft and recipient survival in offspring-to-parent living donor kidney transplantation differs between men and women due to donor-specific alloimmunization during pregnancy. We retrospectively analyzed long-term allograft and patient survival among men and women who received an offspring living donor kidney compared to those who received other haplotype-matched living donor kidneys. By multivariable Cox proportional hazards modeling of Organ Procurement and Transplantation Network data from 2001 to 2015, we found that both men and women who received offspring living donor kidneys had significantly increased mortality compared to recipients who received non-offspring living donor kidneys. While male recipients of any living donor kidney had greater risk of mortality and allograft failure compared to females, there was no significant difference in all-cause allograft failure or mortality in male versus female recipients of offspring living donor kidney transplantations. Our analysis demonstrated no significant interaction between recipient gender and donor offspring status. We conclude that non-offspring living donors should be considered whenever feasible for both men and women with multiple donor options. </p>

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Factors influencing long-term outcome after kidney transplantation.

Christophe Legendre, Guillaume Canaud, Frank Martinez (2014)

Many factors influence the long-term outcome of kidney transplantation, which is defined very schematically by patient death or renal dysfunction leading to graft loss. The most important of these factors is most likely the quality of the transplant itself, with kidneys from living donors showing a positive impact, while kidneys from expanded criteria donors show deleterious impacts. Various clinicopathological scores exist to predict mid- to long-term outcomes and avoid the transplantation of kidneys displaying inferior results. The key factors related to the recipient include their age as well as disease recurrence, HLA matching, HLA immunization, ethnic background, time on dialysis, and cardiovascular comorbidities. Renal function, defined based on estimated GFR and/or proteinuria values, is a result of all these factors. Delayed graft function has a detrimental long-term impact, as does the level of renal function impairment either in stable condition or in case of progressing dysfunction. Finally, although current immunosuppression regimes are highly efficient in preventing acute rejection, the burden of specific (diabetes, nephrotoxicity) and nonspecific (infection and cancer) side effects has significant negative long-term consequences that may well be worse in the future because of the increasing ages of both donors and recipients. The development of safer immunosuppression strategies is therefore crucial to improve long-term outcomes.

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Improved renal ischemia tolerance in females influences kidney transplantation outcomes

David Aufhauser, Zhonglin Wang, Douglas Murken … (2016)

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Predictors and outcomes of delayed graft function after living-donor kidney transplantation.

Robert Redfield, Joseph Scalea, Tiffany J Zens … (2016)

Delayed graft function (DGF) following deceased donor kidney transplantation is associated with inferior outcomes. Delayed graft function following living-donor kidney transplantation is less common, but its impact on graft survival unknown. We therefore sought to determine risk factors for DGF following living-donor kidney transplantation and DGF's effect on living-donor kidney graft survival. We analyzed living-donor kidney transplants performed between 2000 and 2014 in the UNOS dataset. A total of 64 024 living-donor kidney transplant recipients were identified, 3.6% developed DGF. Cold ischemic time, human leukocyte antigen mismatch, donor age, panel reactive antibody, recipient diabetes, donor and recipient body mass index, recipient race and gender, right nephrectomy, open nephrectomy, dialysis status, ABO incompatibility, and previous transplants were independent predictors of DGF in living-donor kidney transplants. Five-year graft survival among living-donor kidney transplant recipients with DGF was significantly lower compared with graft survival in those without DGF (65% and 85%, respectively, P < 0.001). DGF more than doubled the risk of subsequent graft failure (hazard ratio = 2.3, 95% confidence interval: 2.1-2.6; P < 0.001). DGF after living-donor kidney transplantation is associated with inferior allograft outcomes. Minimizing modifiable risk factors may improve outcomes in living-donor kidney transplantation.