Using Scientific Registry of Transplant Recipients data, we analyzed 232,705 kidney transplant recipients that received a transplant from 1998-2012. Graft failure rates were estimated using Cox models for recipients of kidney transplants from living unrelated, living related and deceased donors. Models were adjusted for year of transplant and donor and recipient characteristics with particular attention to mismatches in age, sex, HLA, body size, and weight. The dependence of graft failure on increasing donor age was less pronounced for living donor than for deceased donor transplants. Male donor to male recipient transplants had longer graft survival, particularly better than female to male. HLA mismatch was important in all donor types. Obesity of both the recipient and donor resulted in higher graft loss as did donor-recipient weight ratios of less than 75%. These models are used to create a calculator that estimates five- and ten-year graft survival probabilities based on recipient and donor characteristics. This calculator has obvious use for candidates with multiple donors and has potential importance in the context of kidney paired donation (KPD) programs as is illustrated. Outcomes for transplants from living unrelated donors are of particular importance, but sometimes compatible pairs with a living related donor may be advised to consider joining a KPD program. These models could help guide such decisions.

Table 1 illustrates results from the calculator for a 50 year old male candidate who has three potential living donors, and presents estimated 5- and 10-year graft failure probabilities for each donor. Only partial data is given on the donors, although the variables displayed are of particular importance in estimating graft survival. If donors 2 and 3 were part of a KPD program, there could well be advantage to this candidate if this compatible pair were to join the pool. Incorporating compatible donors could also be of benefit to the KPD.

CITATION INFORMATION: Kalbfleisch J, Ashby V, Leichtman A, Rees M, Song P. X.-L, Sakhuja A, Bray M, Eikstadt R, Goulding A, Wang W. Donor-Candidate Mismatch in Age, Sex, HLA, and Body Size Inform a Calculator for Kidney Graft Survival. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress