Non-Inferiority of Graft Survival of Living Unrelated Kidney Transplant compared to Living Related Kidney Transplant as Analyzed by First Degree Relative
Henry Ford Transplant Institute, Detroit, MI.
Meeting: 2015 American Transplant Congress
Abstract number: B178
Session Information
Session Name: Poster Session B: Living Donor Issues 1
Session Type: Poster Session
Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
The perceived advantage of donating a kidney directly to a family member is difficult to uncouple in the setting of voluntary exchange or other kidney paired donation. There are unclear, long-term risks of rejection, delayed graft function, age mismatch, patient survival (PS) and graft survival (GS) among exchanges which create perceived barriers. We chose to analyze the outcomes of graft survival among live-donor kidney transplants between first degree relative (1KT) and non-first degree relatives (non1KT).
Methods: Using the UNOS database from 1995 to 2013, we evaluated PS and death censored GS (DCGS) among adult living-donor kidney recipients (R). We reviewed differences in PS, DCGS and graft failure (GF) from chronic rejection, DGF among R whose kidney was donated from a 1KT or a non1KT. Median follow up was 5 years. The differences between the groups were tested with Student's t-test or chi-square. The endpoints were plotted using Kaplan Meier analysis. D and R demographic and transplant data were used to allow Cox regression analysis.
Results: Of the 79,218 patients included in the study, 48,996 were 1KTR and 30,222 were non1KTR. Although there was better PS among 1KTR on unadjusted analysis, this result did not persist on regression analysis for PS and PS with functioning graft (p value 0.88 and p 0.57 respectively). There was a small but significant increase in DCGS (Hazard ratio HR: 0.87; p 0.003) and a high DCGS with chronic rejection (HR:0.76 ; p 0.002) detected in non1KTR. No difference in risk of acute rejection (p 0.55) or DGF (p 0.83) was noted between the two groups. D/R age mismatch among others remained a significant for GF regardless of donor type (HR 0.99; p< 0.001) as did level of HLA (HR: 1.1;p<0.001) but not DR mismatch.
| Variable | HR | p-value |
| R age | 0.99 | <0.001 |
| Male Donor | 0.89 | <0.001 |
| Donor eGFR | 0.99 | <0.001 |
| R vascular disease | 1.31 | <0.001 |
| R education level | 0.91 | <0.001 |
Conclusion: There appeared to be no difference in PS and a small increase in GS among non1KTR compared to 1KTR. Given these encouraging results, programs could potentially encourage related pairs to participate in Voluntary Exchange Kidney Paired Donations with non-inferior outcomes, as described for this follow up. We are analyzing combinations of donor and recipient factors to further define risks and benefits in an attempt to alleviate concerns and promote understanding.
To cite this abstract in AMA style:
Patel A, Goggins M, Kim D, Rohini P, Malinzak L. Non-Inferiority of Graft Survival of Living Unrelated Kidney Transplant compared to Living Related Kidney Transplant as Analyzed by First Degree Relative [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/non-inferiority-of-graft-survival-of-living-unrelated-kidney-transplant-compared-to-living-related-kidney-transplant-as-analyzed-by-first-degree-relative/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress