The impact of donor factors on kidney allograft outcomes and infectious complications has been suggested in many previous studies. However, analyses of left/right donor kidney pairs are rarely performed, although individual recipient risk factors may be analyzed in a paired difference test and significantly reduce donor co-founders.

We studied all left/right deceased donor kidney pairs between 2003 and 2015. A total of 174 kidney transplantations were performed from 87 donors. Samples were collected pretransplantation, at +1, +2, and +3 months posttransplantation. Alloreactive T-cells and CMV-specific T-cells were measured using an interferon-γ Elispot assay. To account for identical donor characteristics among left/right pairs a paired difference testing was performed.

Patient survival, allograft survival and allograft function were not correlated among left/right donor kidney pairs (p>0.05). In a paired analysis recipient age, sex, BMI, preformed diabetes, cold ischemia time, HLA-match, and time on dialysis didn't impact allograft outcomes among left/right kidney pairs (p<0.05). The presence of preformed alloreactive T-cells was associated with a higher incidence of delayed allograft function (DGF) and acute cellular rejection, inferior allograft survival and allograft function among kidney pairs. The presence of CMV-specific T-cells was associated with less CMV viremia among kidney pairs. DGF was more likely detected in both kidney pairs than one pair only (p<0.05). Male sex was associated with DGF among kidney pairs (p=0.021). Primary nonfunction, acute cellular rejection, BK viremia, EBV viremia, sepsis, and cancer were more likely detected in one pair only (p<0.05). All 20 cases of BK viremia were detected in one pair only (p<0.001). A higher number of HLA-mismatches was associated with BK viremia among kidney pairs (p=0.006).

Despite an increased incidence of DGF in left/right kidney pairs, our results suggest low impact of donor factors on patient and allograft outcomes. In contrast, our data suggest a strong impact of individual immunological characteristics on acute celluar rejection, allograft survival, and allograft function. Common viral infections don't appear solely attributable to donor origin, but to impaired immunity of the recipient.

CITATION INFORMATION: Schachtner T, Stein M, Reinke P. Donor Factors Show Low Impact on Patient and Kidney Allograft Outcomes: A Paired Analysis of Left/Right Deceased Donor Kidney Pairs. Am J Transplant. 2017;17 (suppl 3).

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