*Purpose: In kidney transplantation, the relative contribution of donor versus other factors on clinical outcomes is unknown.

*Methods: For paired donations from deceased donors resulting in transplants to different recipients, the magnitude of donor effects can be quantified by examining the excess of concordant outcomes within kidney pairs beyond chance concordance. Using OPTN data between the years 2013 – 2017, we examined whether pairs were concordant for delayed graft function, death-censored 1-year graft failure, and death-censored 3-year graft failure.

*Results: Within strata of kidneys of similar quality as measured by the Kidney Donor Profile Index (KDPI), there was evidence of moderate donor effects on delayed graft function (DGF). If a transplanted kidney resulted in DGF, the risk of DGF for the sister kidney was 12-19% higher than baseline rates (Table). We observed moderate donor effects on 1-year graft failure; if a graft failed then the sister kidney’s risk of failure was 2.1- to 2.7-fold higher, or 4-8% higher absolute risk. For 3-year graft failure, the excess absolute risks were also 4-8% and excess relative risks were smaller, 1.3- to 2.0-fold. Rates of graft failure were similar in kidneys in which only one from a pair was transplanted compared to kidneys pairs in which both were transplanted. In kidneys with KDPI 85-100% we observed approximately 85% chance of 3-year graft survival and only modest donor effects.

*Conclusions: Overall results indicated that the donor constitution has minimal to moderate impact on post-transplant clinical outcomes. These findings have potential implications around sharing outcomes across recipients, clinical trials in deceased donors, and alleviating kidney discard. For example, given the modest effects of donor factors on ultimate graft performance, reliance on those factors for decision-making regarding transplant may be misplaced, particularly in light of the risks of continued dialysis.

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