A recent study (AJT, January 2018) suggested that kidneys from offspring live donors conferred worse post-transplant outcomes than non-offspring live donors, and advocated selecting non-offspring live donors when able. However, this study did not account for young age and high HLA match of offspring kidneys; moreover, recipients receiving kidneys from offspring are usually older. We hypothesized that inferior outcomes of kidneys from offspring were confounded by recipient age.

Methods: We compared 8,045 recipients receiving offspring kidneys to 29,828 non-offspring recipients between 2001-2016 using SRTR. We modeled death censored graft failure (DCGF) and recipient mortality using Cox regression. We adjusted for recipient characteristics only, since donor related characteristics are mediators of offspring donors and post-transplant outcomes.

Results: Offspring kidney recipients were older than non-offspring (61 vs 51, p<0.001). Kidneys from offspring had lower DCGF compared to non-offspring kidneys (Figure 1: 15-year cumulative incidence 14.8% vs 20.8%, HR=_0.650.71_0.78, p<0.001). After adjustment, offspring kidneys were still associated with lower risk of DCGF (aHR=_0.670.73_0.81, p<0.001). Although kidneys from offspring were associated with higher unadjusted mortality (Figure 2: 15-year 55.4% vs 37.4%, HR=_1.571.65_1.75, p<0.001), the association largely disappeared after adjustment for recipient age alone (aHR=_1.001.06_1.12, p=0.06) and became non-significant after further adjustment for other recipient characteristics (aHR=_0.910.97_1.03, p=0.3).

Conclusions: Offspring kidneys had lower graft failure and comparable patient mortality compared to non-offspring kidneys. A kidney from an otherwise eligible offspring donor confers no added risk to a patient in need of transplantation.

CITATION INFORMATION: Luo X., Massie A., Holscher C., Segev D. Offspring Living Kidney Donors Should Not Be Ruled Out Am J Transplant. 2017;17 (suppl 3).

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