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
. 2025 Jul 14.
doi: 10.1097/TP.0000000000005464. Online ahead of print.

Identification of Donor-recipient Interactions for a Relative Appraisal of Kidney Graft Marginality: A French Multicentric Cohort-based Study

Corentin Choisy  1 , Yohann Foucher  2 , Christophe Masset  3 , Mehdi Maanaoui  4 , Rémi Lenain  4 , Lionel Rostaing  5 , Thomas Jouve  5 , Moglie Le Quintrec  6   7 , Jean-Emmanuel Serre  6   7 , Emmanuel Morelon  8   9 , Xavier Charmetant  8   9 , Marc Ladriere  10 , Sophie Girerd  10 , Antoine Sicard  11 , Clément Gosset  11 , Christophe Mariat  12 , Guillaume Claisse  12 , Magali Giral  3   13 , Etienne Dantan  1 ; DIVAT Consortium
Collaborators, Affiliations

Identification of Donor-recipient Interactions for a Relative Appraisal of Kidney Graft Marginality: A French Multicentric Cohort-based Study

Corentin Choisy et al. Transplantation. .

Abstract

Background: Kidney marginality criteria consider the impact of donor characteristics on graft failure risk. To evaluate graft quality according to both the donor and recipient, we identified recipient characteristics that may modify the predictive capacity of a donor marginality score.

Methods: From the French DIVAT (Données Informatisées et VAlidées en Transplantation) cohort, we included 8299 patients who received a single deceased donor kidney graft between 2000 and 2022. From the learning sample (n = 5533), we constructed a Cox model with death or return to dialysis as the outcome. The model was both internally (n = 2766) and externally (n = 3178) validated. A recipient-relative marginality score was defined by screening the interactions between recipient characteristics and a donor-only graft marginality score. The scores' performances were compared using time-dependent receiver operating characteristic curves.

Results: Five donor characteristics (age, cerebrovascular death, cytomegalovirus serology, and histories of diabetes and hypertension) defined the donor marginality score. This score had a nonlinear interaction with recipient age. Thus, the level of risk related to marginal kidneys depended on recipient's age. Marginal grafts induced a higher graft failure risk for old recipients (hazard ratio [HR], 1.79 [for a 0.5-unit increase in marginality for a 70-y-old recipient]; 95% confidence interval [CI], 1.40-2.15) compared with middle-age recipients (HR, 1.47 [for a 55-y-old recipient]; 95% CI, 1.34-1.70; HR, 1.36 [for a 40-y-old recipient]; 95% CI, 1.14-1.64). The donor score provided good discrimination on the whole sample but not after stratifying by recipient age. However, the recipient-relative score retained acceptable discrimination in recipients older than 60 y.

Conclusions: Our results suggest that the consideration of candidate profiles may improve graft quality assessments.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Boesmueller C, Biebl M, Scheidl S, et al. Long-term outcome in kidney transplant recipients over 70 years in the Eurotransplant Senior Kidney Transplant Program: a single center experience. Transplantation. 2011;92:210–216.
    1. Tonelli M, Wiebe N, Knoll G, et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant. 2011;11:2093–2109.
    1. Port FK, Bragg-Gresham JL, Metzger RA, et al. Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors. Transplantation. 2002;74:1281–1286.
    1. Rao PS, Schaubel DE, Guidinger MK, et al. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation. 2009;88:231–236.
    1. Dantan E, Le Borgne F, Giral M, et al. Covariates adjustment questioned conclusions of predictive analyses: an illustration with the kidney donor risk index. J Clin Epidemiol. 2021;135:103–114.

LinkOut - more resources