Inferior long-term allograft and patient outcomes among recipients of offspring living donor kidneys

Abstract

While offspring-to-parent living donor kidney transplantations may represent an ideal donor-recipient combination to optimize long-term transplantation outcomes, the sex-specific long-term success of these transplantations remains unclear. We hypothesize that allograft and recipient survivals in offspring-to-parent living donor kidney transplantation differ between men and women due to donor-specific alloimmunization during pregnancy. We retrospectively analyzed long-term allograft and patient survival among men and women who received an offspring living donor kidney compared with those who received other haplotype-matched living donor kidneys. Based on multivariable Cox proportional hazards modeling of Organ Procurement and Transplantation Network data from 2001 to 2015, we found that both men and women who received offspring living donor kidneys had significantly increased mortality compared with recipients who received nonoffspring living donor kidneys. While male recipients of any living donor kidney had greater risk of mortality and allograft failure than female recipients, there was no significant difference in all-cause allograft failure or mortality in male versus female recipients of offspring living donor kidney transplantations. Our analysis demonstrated no significant interaction between recipient sex and donor offspring status. We conclude that nonoffspring living donors should be considered whenever feasible for both men and women with multiple donor options.

Biologic mechanisms and clinical consequences of pregnancy alloimmunization

“…14,15 It may also explain the increased rate of graft loss associated with increasing pregnancy number (ie, gravidity). 16 However, while these data suggest that a history of pregnancy can affect graft survival or rejection rates in select circumstances, multiple analyses of living donor outcomes have not demonstrated poorer graft outcomes among women who receive a kidney from either a spouse or an offspring [16][17][18][19][20] • Child-to-father n = 21…”

Identifying the best donor for the best recipient: Parents may still be better served by nonoffspring donors

“…Although Holscher et al describe using interaction terms in their analyses, 1 our study specifically investigated sex-specific outcomes using stratified analyses throughout the study. 2 With respect to donor characteristics, we chose widely accepted methods of adjusting for recipient and donor factors related to the recipient-donor relationship and our selected outcomes. 2 In addition, we restricted our cohorts to individuals with ≥3 HLA matches (and adjusted for HLA matches), mimicking parent-offspring relationships, to identify a robust nonoffspring control group.…”

“…2 With respect to donor characteristics, we chose widely accepted methods of adjusting for recipient and donor factors related to the recipient-donor relationship and our selected outcomes. 2 In addition, we restricted our cohorts to individuals with ≥3 HLA matches (and adjusted for HLA matches), mimicking parent-offspring relationships, to identify a robust nonoffspring control group. In contrast, Holscher et al addressed donor age and HLA matches as mediators of the association between recipient-donor relationship and allograft outcomes and elected not to adjust for other important donor characteristics (eg, sex and BMI 4 ).…”

Analysis of Factors Influencing Kidney Function of Recipients After Renal Transplantation in Southwestern China: A Retrospective Study

“…Many studies have shown that younger donors result in better outcomes than older donors (7), although some scholars think that renal function can be wasted when kidneys from younger donors are transplanted into older recipients because the recipient may die while the kidney graft is still functional (8). Interestingly, a recent publication by Cohen et al reported that recipients of offspring donors had higher mortality and graft loss (9). BMI is another important factor affecting transplantation outcomes, as donor obesity is a reported risk factor for graft failure.…”