Background Previous studies have shown that education level is associated with the prognosis of cadaveric kidney transplant recipients. However, it is unclear whether education affects the prognosis of living kidney transplant (LDKT) recipients. In addition, it remains to be determined whether the uneven distribution of educational levels consistently affects the prognosis of LDKT recipients across ethnic groups (White, Black, Hispanic and Asian). Methods After establishing inclusion and exclusion criteria, we conducted a retrospective study of LDKT recipients who received their first single LDKT between 2005 and 2020. The LDKT recipients were divided into lower- and higher-education groups according to categorize the educational level of recipients, and transplant outcomes, including graft survival, patient survival, and death-censored graft survival (DCGS), were analyzed and compared. Results Graft survival, DCGS and patient mortality were significantly better in the higher-education group compared with those in the lower-education group (P<0.001), with the risk of graft failure, death censored graft failure (DCGF) and patient mortality increasing by 11%, 15% and 7% in the lower-education group, respectively. Furthermore, compared with the higher-education group, the risk of graft failure in Black recipients increased by 18% [adjusted hazard ratio (aHR), 1.18; 95% confidence interval (CI): 1.07 to 1.30], and the risk of patient mortality among White recipients decreased by 7% (aHR, 0.93; 95% CI: 0.87 to 0.99). However, there were no significant differences in graft failure and patient mortality among Hispanic and Asian recipients, respectively. Conclusions This study revealed that LDKT recipients with a higher education level had better transplant outcomes. However, these transplant outcome differences were mainly found in White and Black recipients. These data confirm the significant effect of different levels of education on the prognosis of LDKT recipients.

BACKGROUND Previous studies have shown that the level of education is associated with the prognosis of cadaveric kidney transplant recipients. However, it is unclear whether education affects the prognosis of living kidney transplant recipients. In addition, it remains to be determined whether the uneven distribution of education levels consistently affects the prognosis of LDKT recipients across ethnic groups. OBJECTIVE The outcomes of LDKT recipients with different levels of education were compared to verify the difference, and the relationship between education level and prognostic risk of LDKT recipients in different races was evaluated. METHODS We conducted a retrospective study of adult recipients who received their first living single kidney transplant from 2005 to 2020. The LDKT recipients were divided into low and high education groups, and the transplant outcomes including graft survival, patient survival, and death-censored graft survival, in the LDKT recipients between these groups were analyzed and compared. RESULTS The graft and patient survival rates in the high education group were better than those in the low education group (P <.001). As compared to the high education group, the risk of graft failure and mortality increased by 11% [hazard ratio (HR), 1.11 (1.06 to 1.15)] and 7% [(HR), 1.07 (1.02 to 1.13)] in the low education group, respectively. The subgroup analysis showed that White, Black, and Asian ethnic groups showed a similar trend. However, there was no significant difference in the graft and patient survival rates among Hispanic groups between the two education groups (P = 0.38 and P = 0.41, respectively). The adjusted risk of graft failure in the low education group decreased 7% [adjusted hazard ratio (aHR), 0.93 (0.88 to 0.98)] in White recipients, increased 19% [(aHR), 1.19 (1.09 to 1.31)] and 31% [(aHR), 1.31 (1.02 to 1.69)] in Black and Asian, respectively. CONCLUSIONS This study showed that the high education level had better transplant outcomes in LDKT recipients, and these differences in transplant outcomes were mainly found in white, black, and Asian recipients.

BackgroundRace is a prognostic indicator in kidney transplant (KT). However, the effect of donor-recipient race-matching on survival after KT remains unclear.MethodsUsing the United Network for Organ Sharing (UNOS) database, a retrospective study was conducted on 244,037 adults who received first-time, kidney-alone transplantation between 2000 and 2019. All patients were categorized into two groups according to donor-recipient race-matching, and the living and deceased donor KT (LDKT and DDKT) were analyzed in subgroups.ResultsOf the 244,037 patients, 149,600 (61%) were race-matched, including 107,351 (87%) Caucasian, 20,741 (31%) African Americans, 17,927 (47%) Hispanics, and 3,581 (25%) Asians. Compared with race-unmatching, race-matching showed a reduced risk of overall mortality and graft loss (unadjusted hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84–0.87; and unadjusted HR 0.79, 95% CI: 0.78–0.80, respectively). After propensity score-matching, donor-recipient race-matching was associated with a decreased risk of overall graft loss (P &lt; 0.001) but not mortality. In subgroup analysis, race-matching was associated with higher crude mortality (HR 1.12, 95% CI: 1.06–1.20 in LDKT and HR 1.11, 95% CI: 1.09–1.14 in DDKT). However, race-matching was associated with a decreased risk of graft loss in DDKT (unadjusted HR 0.97, 95% CI: 0.96–0.99), but not in LDKT. After propensity score-matching, race-matching had better outcomes for LDKT (patient survival, P = 0.047; graft survival, P &lt; 0.001; and death-censored graft survival, P &lt; 0.001) and DDKT (death-censored graft survival, P = 0.018). Nonetheless, race-matching was associated with an increased adjusted mortality rate in the DDKT group (P &lt; 0.001).ConclusionRace-matching provided modest survival advantages after KT but was not enough to influence organ offers. Cofounding factors at baseline led to a contorted crude conclusion in subgroups, which was reversed again to normal trends in the combined analysis due to Simpson's paradox caused by the LDKT/DDKT ratio.