*Purpose: In kidney transplantation, non-immunologic donor-recipient (D-R) pairing is generally not given the same consideration as immunologic matching. The aim of this study was to determine how non-immunologic D-R pairing relates to independent donor and recipient factors, and to immunologic human leukocyte antigen (HLA) match for predicting graft loss.

*Methods: Seven D-R pairings (race, sex, age, weight, height, cytomegalovirus serostatus and HLA match) were assessed for their association with the composite outcome of death or kidney graft loss using a Cox regression-based forward stepwise selection model. The best model for predicting graft loss (including non-immunologic D-R pairings, independent donor/recipient factors, and/or HLA match status) was determined using the Akaike Information Criterion (AIC).

*Results: 23,262 (29.9%) people in the derivation dataset and 9,892 (29.7%) in the validation dataset developed the composite outcome of death or graft loss. A model that included both independent and D-R pairing variables best predicted graft loss. The c-indices for the derivation and validation models were 0.626 and 0.629, respectively. Size mismatch between donor and recipient (> 30 kg (D15 cm (D*Conclusions: D-R pairing is valuable in predicting patient and graft outcomes after kidney transplant. D-R size matching could offset the benefit and harm seen with 0 and 6 HLA-MM, respectively. This supports the need for better efforts to combine more novel immunologic and non-immunologic longevity matching in allocation without compromising equity.

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