Recipient Outcomes Following Transplantation of Allografts From Live Kidney Donors Who Subsequently Developed End-Stage Renal Disease

Abimereki Muzaale, Allan B Massie, S. Anjum, C. Liao, A. X. Garg, K. L. Lentine, Dorry Segev

Research output: Contribution to journalArticle

Abstract

Live kidney donors have an increased risk of end-stage renal disease (ESRD) compared with nondonors; however, it is unknown whether undetected, subclinical kidney disease exists at donation that subsequently contributes to this risk. To indirectly test this hypothesis, the authors followed the donated kidneys, by comparing the outcomes of 257 recipients whose donors subsequently developed ESRD with a matched cohort whose donors remained ESRD free. The compared recipients were matched on donor (age, sex, race/ethnicity, donor-recipient relationship), transplant (HLA mismatch, peak panel-reactive antibody, previous transplantation, year of transplantation), and recipient (age, sex, race/ethnicity, body mass index, cause of ESRD, and time on dialysis) risk factors. Median recipient follow-up was 12.5 years (interquartile range 7.4-17.9, maximum 20 years). Recipients of allografts from donors who developed ESRD had increased death-censored graft loss (74% versus 56% at 20 years; adjusted hazard ratio [aHR] 1.7; 95% confidence interval [CI] 1.5-2.0; p <0.001) and mortality (61% versus 46% at 20 years; aHR 1.5; 95% CI 1.2-1.8; p <0.001) compared with matched recipients of allografts from donors who did not develop ESRD. This association was similar among related, spousal, and unrelated nonspousal donors. These findings support a novel view of the mechanisms underlying donor ESRD: that of pre-donation kidney disease. However, biopsy data may be required to confirm this hypothesis.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - 2016

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Chronic Kidney Failure
Allografts
Transplantation
Tissue Donors
Kidney
Kidney Diseases
Confidence Intervals
Unrelated Donors
Dialysis
Body Mass Index
Transplants
Biopsy
Mortality
Antibodies

Keywords

  • Clinical research/practice
  • Donors and donation: living
  • Kidney transplantation/nephrology
  • Kidney transplantation: living donor

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

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title = "Recipient Outcomes Following Transplantation of Allografts From Live Kidney Donors Who Subsequently Developed End-Stage Renal Disease",
abstract = "Live kidney donors have an increased risk of end-stage renal disease (ESRD) compared with nondonors; however, it is unknown whether undetected, subclinical kidney disease exists at donation that subsequently contributes to this risk. To indirectly test this hypothesis, the authors followed the donated kidneys, by comparing the outcomes of 257 recipients whose donors subsequently developed ESRD with a matched cohort whose donors remained ESRD free. The compared recipients were matched on donor (age, sex, race/ethnicity, donor-recipient relationship), transplant (HLA mismatch, peak panel-reactive antibody, previous transplantation, year of transplantation), and recipient (age, sex, race/ethnicity, body mass index, cause of ESRD, and time on dialysis) risk factors. Median recipient follow-up was 12.5 years (interquartile range 7.4-17.9, maximum 20 years). Recipients of allografts from donors who developed ESRD had increased death-censored graft loss (74{\%} versus 56{\%} at 20 years; adjusted hazard ratio [aHR] 1.7; 95{\%} confidence interval [CI] 1.5-2.0; p <0.001) and mortality (61{\%} versus 46{\%} at 20 years; aHR 1.5; 95{\%} CI 1.2-1.8; p <0.001) compared with matched recipients of allografts from donors who did not develop ESRD. This association was similar among related, spousal, and unrelated nonspousal donors. These findings support a novel view of the mechanisms underlying donor ESRD: that of pre-donation kidney disease. However, biopsy data may be required to confirm this hypothesis.",
keywords = "Clinical research/practice, Donors and donation: living, Kidney transplantation/nephrology, Kidney transplantation: living donor",
author = "Abimereki Muzaale and Massie, {Allan B} and S. Anjum and C. Liao and Garg, {A. X.} and Lentine, {K. L.} and Dorry Segev",
year = "2016",
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language = "English (US)",
journal = "American Journal of Transplantation",
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T1 - Recipient Outcomes Following Transplantation of Allografts From Live Kidney Donors Who Subsequently Developed End-Stage Renal Disease

AU - Muzaale, Abimereki

AU - Massie, Allan B

AU - Anjum, S.

AU - Liao, C.

AU - Garg, A. X.

AU - Lentine, K. L.

AU - Segev, Dorry

PY - 2016

Y1 - 2016

N2 - Live kidney donors have an increased risk of end-stage renal disease (ESRD) compared with nondonors; however, it is unknown whether undetected, subclinical kidney disease exists at donation that subsequently contributes to this risk. To indirectly test this hypothesis, the authors followed the donated kidneys, by comparing the outcomes of 257 recipients whose donors subsequently developed ESRD with a matched cohort whose donors remained ESRD free. The compared recipients were matched on donor (age, sex, race/ethnicity, donor-recipient relationship), transplant (HLA mismatch, peak panel-reactive antibody, previous transplantation, year of transplantation), and recipient (age, sex, race/ethnicity, body mass index, cause of ESRD, and time on dialysis) risk factors. Median recipient follow-up was 12.5 years (interquartile range 7.4-17.9, maximum 20 years). Recipients of allografts from donors who developed ESRD had increased death-censored graft loss (74% versus 56% at 20 years; adjusted hazard ratio [aHR] 1.7; 95% confidence interval [CI] 1.5-2.0; p <0.001) and mortality (61% versus 46% at 20 years; aHR 1.5; 95% CI 1.2-1.8; p <0.001) compared with matched recipients of allografts from donors who did not develop ESRD. This association was similar among related, spousal, and unrelated nonspousal donors. These findings support a novel view of the mechanisms underlying donor ESRD: that of pre-donation kidney disease. However, biopsy data may be required to confirm this hypothesis.

AB - Live kidney donors have an increased risk of end-stage renal disease (ESRD) compared with nondonors; however, it is unknown whether undetected, subclinical kidney disease exists at donation that subsequently contributes to this risk. To indirectly test this hypothesis, the authors followed the donated kidneys, by comparing the outcomes of 257 recipients whose donors subsequently developed ESRD with a matched cohort whose donors remained ESRD free. The compared recipients were matched on donor (age, sex, race/ethnicity, donor-recipient relationship), transplant (HLA mismatch, peak panel-reactive antibody, previous transplantation, year of transplantation), and recipient (age, sex, race/ethnicity, body mass index, cause of ESRD, and time on dialysis) risk factors. Median recipient follow-up was 12.5 years (interquartile range 7.4-17.9, maximum 20 years). Recipients of allografts from donors who developed ESRD had increased death-censored graft loss (74% versus 56% at 20 years; adjusted hazard ratio [aHR] 1.7; 95% confidence interval [CI] 1.5-2.0; p <0.001) and mortality (61% versus 46% at 20 years; aHR 1.5; 95% CI 1.2-1.8; p <0.001) compared with matched recipients of allografts from donors who did not develop ESRD. This association was similar among related, spousal, and unrelated nonspousal donors. These findings support a novel view of the mechanisms underlying donor ESRD: that of pre-donation kidney disease. However, biopsy data may be required to confirm this hypothesis.

KW - Clinical research/practice

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KW - Kidney transplantation/nephrology

KW - Kidney transplantation: living donor

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