Quantifying Donor Effects on Transplant Outcomes Using Kidney Pairs from Deceased Donors

Kathleen F. Kerr, Eric R. Morenz, Heather Thiessen-Philbrook, Steven G. Coca, F. Perry Wilson, Peter P. Reese, Chirag R. Parikh

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1781-1787
Number of pages7
JournalClinical journal of the American Society of Nephrology : CJASN
Volume14
Issue number12
DOIs
StatePublished - Dec 6 2019

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Transplants
Kidney
Confidence Intervals
Delayed Graft Function
Tissue and Organ Procurement
Constitution and Bylaws
Organ Transplantation
Kidney Transplantation

Keywords

  • cadaver organ transplantation
  • confidence intervals
  • death
  • delayed graft function
  • kidney
  • kidney transplantation
  • risk
  • survival
  • tissue donors
  • transplant outcomes
  • transplantation
  • transplants

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Quantifying Donor Effects on Transplant Outcomes Using Kidney Pairs from Deceased Donors. / Kerr, Kathleen F.; Morenz, Eric R.; Thiessen-Philbrook, Heather; Coca, Steven G.; Wilson, F. Perry; Reese, Peter P.; Parikh, Chirag R.

In: Clinical journal of the American Society of Nephrology : CJASN, Vol. 14, No. 12, 06.12.2019, p. 1781-1787.

Research output: Contribution to journalArticle

Kerr, Kathleen F. ; Morenz, Eric R. ; Thiessen-Philbrook, Heather ; Coca, Steven G. ; Wilson, F. Perry ; Reese, Peter P. ; Parikh, Chirag R. / Quantifying Donor Effects on Transplant Outcomes Using Kidney Pairs from Deceased Donors. In: Clinical journal of the American Society of Nephrology : CJASN. 2019 ; Vol. 14, No. 12. pp. 1781-1787.
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abstract = "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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AU - Coca, Steven G.

AU - Wilson, F. Perry

AU - Reese, Peter P.

AU - Parikh, Chirag R.

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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.

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KW - confidence intervals

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KW - delayed graft function

KW - kidney

KW - kidney transplantation

KW - risk

KW - survival

KW - tissue donors

KW - transplant outcomes

KW - transplantation

KW - transplants

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