Amanda J Miller1, Bryce A Kiberd2, Ian P Alwayn3, Ayo Odutayo4, Karthik K Tennankore2. 1. Department of Medicine, Division of Nephrology, and amm977@mail.harvard.edu. 2. Department of Medicine, Division of Nephrology, and. 3. Department of General Surgery, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and. 4. Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
Abstract
BACKGROUND AND OBJECTIVES: Relatively smaller kidney donor to recipient size is proposed to result in higher graft loss due to nephron underdosing and hyperfiltration injury, but the potentially additive effect of sex and weight mismatch has not been explored in detail. The purpose of this study was to determine if concurrent donor and recipient absolute weight and sex mismatch was associated with graft loss in a cohort of deceased donor kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The association of kidney donor and recipient absolute weight and sex difference with death-censored graft loss was explored using a cohort of United States deceased donor recipients between 2000 and 2014 through the Scientific Registry of Transplants Recipients. Donor-recipient sex pairings (male donor-male recipient; female donor-female recipient; male donor-female recipient; female donor-male recipient) were further stratified by donor and recipient absolute weight difference (>30 or 10-30 kg [donor<recipient; donor>recipient] or <10 kg [donor=recipient]) resulting in 20 weight and sex pairings. Time to death-censored graft loss for each pairing was evaluated using multivariable Cox proportional hazards models adjusting for donor, immunologic, surgical, and recipient predictors of graft loss compared with the reference group of male donor-male recipients with no weight mismatch (<10 kg difference). RESULTS: Of 115,124 kidney transplant recipients, 21,261 developed death-censored graft failure (median graft survival time was 3.8 years; quartile 1 to 3, 0.0 to 14.8 years). After multivariable adjustment, the highest relative hazards for graft failure were observed for female recipients of male donor kidneys and male recipients of female donor kidneys in situations where the recipient was >30 kg larger than donor (hazard ratio, 1.50; 95% confidence interval, 1.32 to 1.70; hazard ratio, 1.35; 95% confidence interval, 1.25 to 1.45, respectively). CONCLUSIONS: A concurrent mismatch in donor-recipient weight (donor<recipient) and donor-recipient sex is associated with a higher risk of death-censored graft loss in kidney transplantation.
BACKGROUND AND OBJECTIVES: Relatively smaller kidney donor to recipient size is proposed to result in higher graft loss due to nephron underdosing and hyperfiltration injury, but the potentially additive effect of sex and weight mismatch has not been explored in detail. The purpose of this study was to determine if concurrent donor and recipient absolute weight and sex mismatch was associated with graft loss in a cohort of deceased donor kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The association of kidney donor and recipient absolute weight and sex difference with death-censored graft loss was explored using a cohort of United States deceased donor recipients between 2000 and 2014 through the Scientific Registry of Transplants Recipients. Donor-recipient sex pairings (male donor-male recipient; female donor-female recipient; male donor-female recipient; female donor-male recipient) were further stratified by donor and recipient absolute weight difference (>30 or 10-30 kg [donor<recipient; donor>recipient] or <10 kg [donor=recipient]) resulting in 20 weight and sex pairings. Time to death-censored graft loss for each pairing was evaluated using multivariable Cox proportional hazards models adjusting for donor, immunologic, surgical, and recipient predictors of graft loss compared with the reference group of male donor-male recipients with no weight mismatch (<10 kg difference). RESULTS: Of 115,124 kidney transplant recipients, 21,261 developed death-censored graft failure (median graft survival time was 3.8 years; quartile 1 to 3, 0.0 to 14.8 years). After multivariable adjustment, the highest relative hazards for graft failure were observed for female recipients of male donor kidneys and male recipients of female donor kidneys in situations where the recipient was >30 kg larger than donor (hazard ratio, 1.50; 95% confidence interval, 1.32 to 1.70; hazard ratio, 1.35; 95% confidence interval, 1.25 to 1.45, respectively). CONCLUSIONS: A concurrent mismatch in donor-recipient weight (donor<recipient) and donor-recipient sex is associated with a higher risk of death-censored graft loss in kidney transplantation.
Authors: Melissa J Azur; Elizabeth A Stuart; Constantine Frangakis; Philip J Leaf Journal: Int J Methods Psychiatr Res Date: 2011-03 Impact factor: 4.035
Authors: Jennifer McGee; Jeanette H Magnus; Tareq M Islam; Bernard M Jaffe; Rubin Zhang; Sander S Florman; L Lee Hamm; Navyata Mruthinti; Karen Sullivan; Douglas P Slakey Journal: J Am Coll Surg Date: 2010-05 Impact factor: 6.113
Authors: P S Almond; A Matas; K Gillingham; D L Dunn; W D Payne; P Gores; R Gruessner; J S Najarian Journal: Transplantation Date: 1993-04 Impact factor: 4.939
Authors: Lei Wang; Ximing Wang; Helena Y Qu; Shan Jiang; Jie Zhang; Liying Fu; Jacentha Buggs; Bo Pang; Jin Wei; Ruisheng Liu Journal: Hypertension Date: 2017-10-23 Impact factor: 10.190
Authors: Courtenay M Holscher; Tanveen Ishaque; Christine E Haugen; Kyle R Jackson; Jacqueline M Garonzik Wang; Yifan Yu; Fawaz Al Ammary; Dorry L Segev; Allan B Massie Journal: Transplantation Date: 2020-03 Impact factor: 5.385
Authors: Arpita Basu; Mikel Prieto; Catherine Kosberg; Martin L Mai; Hasan A Khamash; Caroline C Jadlowiec; Naim S Issa; Patrick G Dean; Elizabeth C Lorenz; Mark D Stegall; Carrie A Schinstock Journal: Transplantation Date: 2020-06 Impact factor: 5.385