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The differential impact of size mismatch in live versus deceased donor kidney transplant
Author(s) -
Vinson Amanda,
Skinner Tom,
Kiberd Bryce,
Clark David,
Tennankore Karthik
Publication year - 2021
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14310
Subject(s) - medicine , relative risk , kidney transplant , surgery , proportional hazards model , kidney transplantation , transplantation , urology , confidence interval
Background The impact of weight mismatch between donors and recipients (D‐R) undergoing living‐donor kidney transplant (LDKT) versus weight‐matched deceased donor kidney transplant (DDKT) is not established. Aim To determine whether absolute weight mismatch between D‐R affects graft survival following LDKT and how this relates to graft outcomes with DDKT when D‐R are weight matched. Materials & Methods We used multivariable Cox proportional hazards models and the Scientific Registry of Transplant Recipients to determine the association of weight‐mismatched D‐R (>50 kg, 30–50 kg or 10–30 kg ((D < R); (D > R) and <10 kg (D = R)) with death‐censored graft failure in US LDKT recipients from 2006 to 2017. We also explored outcomes relative to weight‐matched DDKT and finally, the impact of combined D‐R weight‐sex mismatch. Results In LDKT, the risk of graft loss was highest in the setting of D < R (HR 1.28, 95% CI 1.05–1.56 for >50 kg difference relative to D = R); however, this was still lower risk than weight‐matched DDKT. D‐R sex and combined weight‐sex mismatch were only important for male recipients (HR 1.47, 95% CI 1.27–1.71 for a male recipient >30 kg larger than their female donor, relative to weight‐matched male donor‐male recipient). This remained superior to weight‐sex‐matched DDKT however. Conclusion D‐R weight‐sex mismatch is important in LDKT; however, graft survival remains superior to proceeding with matched DDKT. Optimizing D‐R matching in LDKT could be facilitated through a national kidney‐paired donation registry. LDKT weight‐sex mismatch should not be deferred in favor of DDKT.