Effect of recipient-donor sex and weight mismatch on graft survival after deceased donor renal transplantation

Abstract

This study evaluated the combined effect of recipient-to-donor weight and sex mismatch after deceased-donor renal transplantation in a German transplant cohort and the evolution of recipient-to-donor weight difference over a 13-year observation period. The association of absolute weight and sex difference with graft failure was explored in an outpatient cohort of deceased-donor transplant recipients who underwent kidney transplantation between 2000 and 2012. Graft failure was defined as repeated need for dialysis or death with a functioning graft. Recipient and donor sex pairings were classified as sex concordant (MDMR/FDFR) or discordant (MDFR/FDMR). These classes were further stratified into four groups according to recipient-to-donor weight mismatch ≥10 kg (recipient > donor) or <10 kg (recipient < donor). Multivariable Cox proportional hazards models were applied to evaluate the time to graft loss adjusting for donor, immunologic, surgical, organizational, and recipient predictors. Sex-concordant transplant pairings <10 kg weight difference served as the reference group. Among 826 transplant recipients, 154 developed graft failure (18.6%). Median graft survival time was 3.9 years; first quartile (0.2–1.2), second quartile (1.2–2.9), third quartile (2.9–5.8), and fourth quartile (5.8–12.4). After multivariable adjustment, the highest relative hazard for graft failure was observed for sex-discordant transplant pairings with a ≥10 kg weight difference between recipient and donor (compared to the reference group MDMR/FDFR with weight difference <10 kg, MDMR/FDFR with weight difference ≥10 kg, hazard ratio 1.86, 95% confidence interval 1.07–3.32—p = 0.029; MDFR/FDMR with weight difference <10 kg, hazard ratio 1.14, 95% confidence interval 0.78–1.68—p = 0.507, and MDFR/FDMR with weight difference ≥10 kg, hazard ratio 2.00, 95% confidence interval 1.15–3.48—p = 0.014). A recipient-to-donor weight mismatch of ≥10 kg was associated with an increased risk of graft loss or recipient death with a functioning graft. Concurrent sex discordance seemed to enhance this effect as indicated by an increase in the hazard ratio. We detected no significant tendency for increasing recipient-to-donor weight differences from 2000 to 2012.

Multivariate online regression analysis with heterogeneous streaming data

“…The major findings are as follows: (i) Donor–recipient height ratio and donor–recipient weight ratio are the top two risk factors. Such an association between donor–recipient weight mismatch (donor<recipient) and graft failure has also been found in Miller et al (2017) and Tillmann et al (2019). (ii) Recipients with younger ages and matched‐race transplants show better graft function.…”

Combined Donor-Recipient Obesity and the Risk of Graft Loss After Kidney Transplantation

“…No studies to date have assessed the potential interaction between donor and recipient obesity on graft outcomes. Importantly, weight mismatch between kidney donors and recipients (DR) has been shown to associate with graft outcomes; recipients receiving organs from relatively smaller donors experience significantly worse outcomes than those receiving kidneys from weight-matched or larger donors ( 19 , 20 , 21 , 22 , 23 ). However, whether donor and/or recipient obesity modifies the association between DR weight mismatch and transplant outcomes has not been previously examined.…”

Donor–Recipient BSA Matching Is Prognostically Significant in Solitary and En Bloc Kidney Transplantation From Pediatric Circulatory Death Donors

“…[17][18][19]37 Additionally, worse patient and graft survivals have been reported between poorly size-matched donor-recipient pairs. 38,39 Obscuring the impact of graft size is compensatory renal hypertrophy observed after transplantation from small donors. 40 However, renal hypertrophy is known to poorly compensate for proteinuria and may be associated with progressive chronic renal injury.…”