The differential impact of size mismatch in live versus deceased donor kidney transplant.
allocation
deceased donor
kidney transplantation
living donor
size mismatch
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
03
03
2021
received:
19
11
2020
accepted:
31
03
2021
pubmed:
6
4
2021
medline:
29
6
2021
entrez:
5
4
2021
Statut:
ppublish
Résumé
The impact of weight mismatch between donors and recipients (D-R) undergoing living-donor kidney transplant (LDKT) versus weight-matched deceased donor kidney transplant (DDKT) is not established. To determine whether absolute weight mismatch between D-R affects graft survival following LDKT and how this relates to graft outcomes with DDKT when D-R are weight matched. We used multivariable Cox proportional hazards models and the Scientific Registry of Transplant Recipients to determine the association of weight-mismatched D-R (>50 kg, 30-50 kg or 10-30 kg ((D < R); (D > R) and <10 kg (D = R)) with death-censored graft failure in US LDKT recipients from 2006 to 2017. We also explored outcomes relative to weight-matched DDKT and finally, the impact of combined D-R weight-sex mismatch. In LDKT, the risk of graft loss was highest in the setting of D < R (HR 1.28, 95% CI 1.05-1.56 for >50 kg difference relative to D = R); however, this was still lower risk than weight-matched DDKT. D-R sex and combined weight-sex mismatch were only important for male recipients (HR 1.47, 95% CI 1.27-1.71 for a male recipient >30 kg larger than their female donor, relative to weight-matched male donor-male recipient). This remained superior to weight-sex-matched DDKT however. D-R weight-sex mismatch is important in LDKT; however, graft survival remains superior to proceeding with matched DDKT. Optimizing D-R matching in LDKT could be facilitated through a national kidney-paired donation registry. LDKT weight-sex mismatch should not be deferred in favor of DDKT.
Sections du résumé
BACKGROUND
The impact of weight mismatch between donors and recipients (D-R) undergoing living-donor kidney transplant (LDKT) versus weight-matched deceased donor kidney transplant (DDKT) is not established.
AIM
To determine whether absolute weight mismatch between D-R affects graft survival following LDKT and how this relates to graft outcomes with DDKT when D-R are weight matched.
MATERIALS & METHODS
We used multivariable Cox proportional hazards models and the Scientific Registry of Transplant Recipients to determine the association of weight-mismatched D-R (>50 kg, 30-50 kg or 10-30 kg ((D < R); (D > R) and <10 kg (D = R)) with death-censored graft failure in US LDKT recipients from 2006 to 2017. We also explored outcomes relative to weight-matched DDKT and finally, the impact of combined D-R weight-sex mismatch.
RESULTS
In LDKT, the risk of graft loss was highest in the setting of D < R (HR 1.28, 95% CI 1.05-1.56 for >50 kg difference relative to D = R); however, this was still lower risk than weight-matched DDKT. D-R sex and combined weight-sex mismatch were only important for male recipients (HR 1.47, 95% CI 1.27-1.71 for a male recipient >30 kg larger than their female donor, relative to weight-matched male donor-male recipient). This remained superior to weight-sex-matched DDKT however.
CONCLUSION
D-R weight-sex mismatch is important in LDKT; however, graft survival remains superior to proceeding with matched DDKT. Optimizing D-R matching in LDKT could be facilitated through a national kidney-paired donation registry. LDKT weight-sex mismatch should not be deferred in favor of DDKT.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14310Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Vinson AJ, Kiberd BA, Davis RB, Tennankore KK. Nonimmunologic donor-recipient pairing, HLA matching, and graft loss in deceased donor kidney transplantation. Transplant Direct. 2019;5:e414.
Miller AJ, Kiberd BA, Alwayn IP, Odutayo A, Tennankore KK. Donor-recipient weight and sex mismatch and the risk of graft loss in renal transplantation. Clin J Am Soc Nephrol. 2017;12:669-676.
Opelz G, Dohler B. Effect of human leukocyte antigen compatibility on kidney graft survival: comparative analysis of two decades. Transplantation. 2007;84:137-143.
Kasiske BL, Snyder JJ, Gilbertson D. Inadequate donor size in cadaver kidney transplantation. J Am Soc Nephrol. 2002;13:2152-2159.
Giral M, Foucher Y, Karam G, et al. Kidney and recipient weight incompatibility reduces long-term graft survival. J Am Soc Nephrol. 2010;21:1022-1029.
Hariharan S, Johnson CP, Bresnahan BA, et al. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med. 2000;342:605-612.
Metzger RA, Delmonico FL, Feng S, et al. Expanded criteria donors for kidney transplantation. Am J Transplant. 2003;3(Suppl. 4):114-125.
Grady RW, Novick AC. Hyperfiltration of renal injury: pathophysiology and clinical implications. Urology. 1996;47:273-283.
Modlin C, Goldfarb D, Novick AC. Hyperfiltration nephropathy as a cause of late graft loss in renal transplantation. World J Urol. 1996;14:256-264.
Gratwohl A, Döhler B, Stern M, Opelz G. H-Y as a minor histocompatibility antigen in kidney transplantation: a retrospective cohort study. Lancet. 2008;372:49-53.
El-Agroudy AE, Hassan NA, Bakr MA, et al. Effect of donor/recipient body weight mismatch on patient and graft outcome in living-donor kidney transplantation. Am J Nephrol. 2003;23:294-299.
Dick AA, Mercer LD, Smith JM, McDonald RA, Young B, Healey PJ. Donor and recipient size mismatch in adolescents undergoing living-donor renal transplantation affect long-term graft survival. Transplantation. 2013;96:555-559.
McGee J, Magnus JH, Islam TM, et al. Donor-recipient gender and size mismatch affects graft success after kidney transplantation. J Am Coll Surg. 2010;210(5):718-725.
Douverny JB, Baptista-Silva JC, Pestana JO, Sesso R. Importance of renal mass on graft function outcome after 12 months of living donor kidney transplantation. Nephrol Dial Transplant. 2007;22:3646-3651.
Poggio ED, Hila S, Stephany B, et al. Donor kidney volume and outcomes following live donor kidney transplantation. Am J Transplant. 2006;6:616-624.
Kayler LK, Rasmussen CS, Dykstra DM, et al. Gender imbalance and outcomes in living donor renal transplantation in the United States. Am J Transplant. 2003;3:452-458.
Nyengaard JR, Bendtsen TF. Glomerular number and size in relation to age, kidney weight, and body surface in normal man. Anat Rec. 1992;232:194-201.
Chang P, Gill J, Dong J, et al. Living donor age and kidney allograft half-life: implications for living donor paired exchange programs. Clin J Am Soc Nephrol. 2012;7:835-841.
Cecka JM. The OPTN/UNOS renal transplant registry 2003. Clin Transpl. 2003;2003:1-12.
Gjertson DW. Look-up survival tables for living-donor renal transplants: OPTN/UNOS data 1995-2002. Clin Transpl. 2003;2003:337-386.
Davis CL, Delmonico FL. Living-donor kidney transplantation: a review of the current practices for the live donor. J Am Soc Nephrol. 2005;16:2098-2110.