Risk Factors for 1-Year Graft Loss After Kidney Transplantation

Abstract

Background and objectivesWith expansion of the pool of kidney grafts, through the use of higher-risk donors, and increased attention to donor management strategies, the 1-year graft survival rate is subject to change. It is, therefore, useful to elucidate 1-year graft survival rates by dissecting the characteristics of the low-risk and high-risk kidney transplant cases. The objective of our study was to evaluate factors purported to influence the risk of 1-year graft loss in kidney transplant recipients.Design, setting, participants, & measurementsWe searched bibliographic databases from 2000 to 2017 and included observational studies that measured the association between donor, recipient, the transplant operation, or early postoperative complications, and 1-year death-censored graft loss.ResultsWe identified 35 eligible primary studies, with 20 risk factors amenable to meta-analysis. Six factors were associated with graft loss, with moderate to high degree of certainty: donor age (hazard ratio [HR], 1.11 per 10-year increase; 95% confidence interval [95% CI], 1.04 to 1.18), extended criteria donors (HR, 1.35; 95% CI, 1.28 to 1.42), deceased donors (HR, 1.54; 95% CI, 1.32 to 1.82), number of HLA mismatches (HR, 1.08 per one mismatch increase; 95% CI, 1.07 to 1.09), recipient age (HR, 1.17 per 10-year increase; 95% CI, 1.09 to 1.25), and delayed graft function (HR, 1.89; 95% CI, 1.46 to 2.47) as risk factors for 1-year graft loss. Pooled analyses also excluded, with a high degree of certainty, any associations of cold ischemia time, recipient race, pretransplant body mass index, diabetes, and hypertension with 1-year graft loss.ConclusionsRecipient age, donor age, standard versus extended criteria donor, living versus deceased donor, HLA mismatch, and delayed graft function all predicted 1-year graft survival. The effect of each risk factor is small.

Impact of HLA compatibility in recipients of kidneys from expanded criteria donors: A Collaborative Transplant Study Report

“…A high degree of HLA incompatibility between donor and recipient has been shown to predispose to development of de novo donor‐specific HLA antibodies (DSAs) as well as to reactivation of preformed DSAs (Dreyer & de Fijter, 2020; Foroutan et al., 2019; Mohan et al., 2012). This may lead to antibody‐mediated rejection and subsequently impair long‐term allograft survival (Mehra & Baranwal, 2016; Slavcev, 2013).…”

Clinical applications of uterus transplantation in China: Issues to take into consideration

“…According to the data of liver transplantation from China Liver Transplant Registry (http://www.cltr.org/), 92.63% of the donated livers were procured from DD, with 76.01% 1‐year graft survival, which is a little lower than that from the living donors (1‐year, 82.53%) . A recent study in kidney transplantation also showed that DD is a risk factor for 1‐year graft loss, though the effect is small . However, another study showed that grafts from different donor types have similar graft survival rates .…”

“…38 A recent study in kidney transplantation also showed that DD is a risk factor for 1-year graft loss, though the effect is small. 39 However, another study showed that grafts from different donor types have similar graft survival rates. 40,41 If uterine graft survival is defined as graft survival past 12 months postoperatively, then the total graft survival rate was 67% (29/43) in the recipients reported up to date, including 71% (22/31) and 58% (7/12) from the living and DD, respectively.…”

Transplanting the Elderly: Mandatory Age- and Minimal Histocompatibility Matching

“…There are several risk factors for the formation of DSA and not surprisingly, non-adherence or lowering immunosuppressive drugs for clinical reasons play a crucial role (44)(45)(46)(47)(48). However, one can only form antibodies if there is a foreign HLA molecule and therefore the main risk factor is the degree of HLA mismatch between the recipient and the donor (49). Several studies show that HLA class II mismatch, in particular HLA-DQ, is most important (40,41,50).…”