Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 15;11(8):2222.
doi: 10.3390/jcm11082222.

Transplant and Recipient Factors in Prediction of Kidney Transplant Outcomes: A UK-Wide Paired Analysis

Richard Dumbill  1   2 , Roderick Jaques  3 , Matthew Robb  3 , Rachel Johnson  3 , Rutger J Ploeg  1   4 , Maria E Kaisar  1   4 , Edward J Sharples  2
Affiliations

Transplant and Recipient Factors in Prediction of Kidney Transplant Outcomes: A UK-Wide Paired Analysis

Richard Dumbill et al. J Clin Med. .

Abstract

Background: In kidney transplantation, the relative contribution of various donor, procedure and recipient-related factors on clinical outcomes is unknown. Previous paired studies have largely focused on examining factors predicting early outcomes, where the effect of donor factors is thought to be most important. Here, we sought to examine the relationship between early and long-term outcomes in a UK-wide paired kidney analysis.

Methods: UK Transplant Registry data covering 24,090 kidney transplants performed between 2001-2018, where both kidneys from each donor were transplanted, were analysed. Case-control studies were constructed using matched pairs of kidneys from the same donor discordant for outcome, to delineate the impact of transplant and recipient factors on longer-term outcomes.

Results: Multivariable conditional logistic regression identified HLA mismatch as an important predictor of prolonged delayed graft function (DGF), in the context of a paired study controlling for the influence of donor factors, even when adjusting for early acute rejection. Prolonged DGF, but not human leucocyte antigen (HLA) mismatch, strongly predicted 12-month graft function, and impaired 12-month graft function was associated with an increased risk of graft failure.

Conclusions: This study indicates prolonged DGF is associated with adverse long-term outcomes and suggests that alloimmunity may contribute to prolonged DGF by a mechanism distinct from typical early acute rejection.

Keywords: delayed graft function; graft function; kidney transplantation; paired.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study Population Selection (prolonged DGF). Consort-type flow diagram showing selection of the case-control cohort for analysis 1 (prolonged DGF). 1328 outcome-discordant transplants were identified for inclusion in this study.
Figure 2
Figure 2
Study Population Selection (12-month eGFR).
Figure 3
Figure 3
Graft survival curves for the analysis 2 cohort (discordant on 12-month function), up to 18 years post-transplant. 12-month survival is 100% in this case-control study cohort by selection. Again, by design, one kidney from each donor is included in each of the two groups. This figure shows that when donor factors are controlled, 12-month functional category defined using an eGFR cut-off of 45 mL/min is a highly significant predictor of graft survival (p < 0.0001, log-rank test).
See this image and copyright information in PMC

References

    1. Quiroga I., McShane P., Koo D.D.H., Gray D., Friend P.J., Fuggle S., Darby C. Major effects of delayed graft function and cold ischaemia time on renal allograft survival. Nephrol. Dial. Transplant. 2006;21:1689–1696. doi: 10.1093/ndt/gfl042. - DOI - PubMed
    1. Avigan Z.M., Singh N., Kliegel J.A., Weiss M., Moeckel G.W., Cantley L.G. Tubular cell dropout in preimplantation deceased donor biopsies as a predictor of delayed graft function. Transplant. Direct. 2021;7:e716. doi: 10.1097/TXD.0000000000001168. - DOI - PMC - PubMed
    1. Cherukuri A., Mehta R., Sood P., Hariharan S. Early allograft inflammation and scarring associate with graft dysfunction and poor outcomes in renal transplant recipients with delayed graft function: A prospective single center cohort study. Transpl. Int. 2018;31:1369–1379. doi: 10.1111/tri.13318. - DOI - PubMed
    1. Johnson R.J., Bradbury L.L., Martin K., Neuberger J. Organ donation and transplantation in the UK-The last decade: A report from the UK national transplant registry. Transplantation. 2014;97:S1–S27. doi: 10.1097/01.TP.0000438215.16737.68. - DOI - PubMed
    1. Rao P.S., Schaubel D.E., Guidinger M.K., Andreoni K.A., Wolfe R.A., Merion R.M., Port F.K., Sung R.S. A comprehensive risk quantification score for deceased donor kidneys: The kidney donor risk index. Transplantation. 2009;88:231–236. doi: 10.1097/TP.0b013e3181ac620b. - DOI - PubMed