Donor characteristics and their impact on kidney transplantation outcomes: results from two nationwide instrumental variable analyses based on outcomes of donor kidney pairs accepted for transplantation
<strong>Background<br></strong> Donor-characteristics and donor characteristics-based decision algorithms are being progressively used in the decision process whether or not to accept an available donor kidney graft for transplantation. While this may improve outcomes, the performa...
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2022
|
| _version_ | 1826307950984036352 |
|---|---|
| author | Schaapherder, AF Kaisar, M Mumford, L Robb, M Johnson, R de Kok, MJC Bemelman, FJ van de Wetering, J van Zuilen, AD Christiaans, MHL Baas, MC Nurmohamed, AS Berger, SP Bastiaannet, E de Vries, APJ Sharples, E Ploeg, RJ Lindeman, JHN |
| author_facet | Schaapherder, AF Kaisar, M Mumford, L Robb, M Johnson, R de Kok, MJC Bemelman, FJ van de Wetering, J van Zuilen, AD Christiaans, MHL Baas, MC Nurmohamed, AS Berger, SP Bastiaannet, E de Vries, APJ Sharples, E Ploeg, RJ Lindeman, JHN |
| author_sort | Schaapherder, AF |
| collection | OXFORD |
| description | <strong>Background<br></strong>
Donor-characteristics and donor characteristics-based decision algorithms are being progressively used in the decision process whether or not to accept an available donor kidney graft for transplantation. While this may improve outcomes, the performance characteristics of the algorithms remains moderate. To estimate the impact of donor factors of grafts accepted for transplantation on transplant outcomes, and to test whether implementation of donor-characteristics-based algorithms in clinical decision-making is justified, we applied an instrumental variable analysis to outcomes for kidney donor pairs transplanted in different individuals.
<br><strong>Methods<br></strong>
This analysis used (dis)congruent outcomes of kidney donor pairs as an instrument and was based on national transplantation registry data for all donor kidney pairs transplanted in separate individuals in the Netherlands (1990-2018, 2,845 donor pairs), and the United Kingdom (UK, 2000-2018, 11,450 pairs). Incident early graft loss (EGL) was used as the primary discriminatory factor. It was reasoned that a scenario with a dominant impact of donor variables on transplantation outcomes would result in high concordance of EGL in both recipients, whilst dominance of asymmetrical outcomes could indicate a more complex scenario, involving an interaction of donor, procedural and recipient factors.
<br><strong>Findings<br></strong>
Incidences of congruent EGL (Netherlands: 1·2%, UK: 0·7%) were slightly lower than the arithmetical (stochastic) incidences, suggesting that once a graft has been accepted for transplantation, donor factors minimally contribute to incident EGL. A long-term impact of donor factors was explored by comparing outcomes for functional grafts from donor pairs with asymmetrical vs. symmetrical outcomes. Recipient survival was similar for both groups, but a slightly compromised graft survival was observed for grafts with asymmetrical outcomes in the UK cohort: (10-years Hazard Ratio for graft loss: 1·18 [1·03-1·35] p<0·018); and 5 years eGFR (48·6 [48·3–49·0] vs. 46·0 [44·5–47·6] ml/min in the symmetrical outcome group, p<0·001).
<br><strong>Interpretation<br></strong>
Our results suggest that donor factors for kidney grafts deemed acceptable for transplantation impact minimally on transplantation outcomes. A strong reliance on donor factors and/or donor-characteristics-based decision algorithms could result in unjustified rejection of grafts. Future efforts to optimize transplant outcomes should focus on a better understanding of the recipient factors underlying transplant outcomes.
<br><strong>Funding<br></strong>
None. |
| first_indexed | 2024-03-07T07:12:19Z |
| format | Journal article |
| id | oxford-uuid:76120c7f-3d3f-4e95-ad1a-a41ee8fe72b1 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:12:19Z |
| publishDate | 2022 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:76120c7f-3d3f-4e95-ad1a-a41ee8fe72b12022-07-04T13:08:29ZDonor characteristics and their impact on kidney transplantation outcomes: results from two nationwide instrumental variable analyses based on outcomes of donor kidney pairs accepted for transplantationJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:76120c7f-3d3f-4e95-ad1a-a41ee8fe72b1EnglishSymplectic ElementsElsevier2022Schaapherder, AFKaisar, MMumford, LRobb, MJohnson, Rde Kok, MJCBemelman, FJvan de Wetering, Jvan Zuilen, ADChristiaans, MHLBaas, MCNurmohamed, ASBerger, SPBastiaannet, Ede Vries, APJSharples, EPloeg, RJLindeman, JHN<strong>Background<br></strong> Donor-characteristics and donor characteristics-based decision algorithms are being progressively used in the decision process whether or not to accept an available donor kidney graft for transplantation. While this may improve outcomes, the performance characteristics of the algorithms remains moderate. To estimate the impact of donor factors of grafts accepted for transplantation on transplant outcomes, and to test whether implementation of donor-characteristics-based algorithms in clinical decision-making is justified, we applied an instrumental variable analysis to outcomes for kidney donor pairs transplanted in different individuals. <br><strong>Methods<br></strong> This analysis used (dis)congruent outcomes of kidney donor pairs as an instrument and was based on national transplantation registry data for all donor kidney pairs transplanted in separate individuals in the Netherlands (1990-2018, 2,845 donor pairs), and the United Kingdom (UK, 2000-2018, 11,450 pairs). Incident early graft loss (EGL) was used as the primary discriminatory factor. It was reasoned that a scenario with a dominant impact of donor variables on transplantation outcomes would result in high concordance of EGL in both recipients, whilst dominance of asymmetrical outcomes could indicate a more complex scenario, involving an interaction of donor, procedural and recipient factors. <br><strong>Findings<br></strong> Incidences of congruent EGL (Netherlands: 1·2%, UK: 0·7%) were slightly lower than the arithmetical (stochastic) incidences, suggesting that once a graft has been accepted for transplantation, donor factors minimally contribute to incident EGL. A long-term impact of donor factors was explored by comparing outcomes for functional grafts from donor pairs with asymmetrical vs. symmetrical outcomes. Recipient survival was similar for both groups, but a slightly compromised graft survival was observed for grafts with asymmetrical outcomes in the UK cohort: (10-years Hazard Ratio for graft loss: 1·18 [1·03-1·35] p<0·018); and 5 years eGFR (48·6 [48·3–49·0] vs. 46·0 [44·5–47·6] ml/min in the symmetrical outcome group, p<0·001). <br><strong>Interpretation<br></strong> Our results suggest that donor factors for kidney grafts deemed acceptable for transplantation impact minimally on transplantation outcomes. A strong reliance on donor factors and/or donor-characteristics-based decision algorithms could result in unjustified rejection of grafts. Future efforts to optimize transplant outcomes should focus on a better understanding of the recipient factors underlying transplant outcomes. <br><strong>Funding<br></strong> None. |
| spellingShingle | Schaapherder, AF Kaisar, M Mumford, L Robb, M Johnson, R de Kok, MJC Bemelman, FJ van de Wetering, J van Zuilen, AD Christiaans, MHL Baas, MC Nurmohamed, AS Berger, SP Bastiaannet, E de Vries, APJ Sharples, E Ploeg, RJ Lindeman, JHN Donor characteristics and their impact on kidney transplantation outcomes: results from two nationwide instrumental variable analyses based on outcomes of donor kidney pairs accepted for transplantation |
| title | Donor characteristics and their impact on kidney transplantation outcomes: results from two nationwide instrumental variable analyses based on outcomes of donor kidney pairs accepted for transplantation |
| title_full | Donor characteristics and their impact on kidney transplantation outcomes: results from two nationwide instrumental variable analyses based on outcomes of donor kidney pairs accepted for transplantation |
| title_fullStr | Donor characteristics and their impact on kidney transplantation outcomes: results from two nationwide instrumental variable analyses based on outcomes of donor kidney pairs accepted for transplantation |
| title_full_unstemmed | Donor characteristics and their impact on kidney transplantation outcomes: results from two nationwide instrumental variable analyses based on outcomes of donor kidney pairs accepted for transplantation |
| title_short | Donor characteristics and their impact on kidney transplantation outcomes: results from two nationwide instrumental variable analyses based on outcomes of donor kidney pairs accepted for transplantation |
| title_sort | donor characteristics and their impact on kidney transplantation outcomes results from two nationwide instrumental variable analyses based on outcomes of donor kidney pairs accepted for transplantation |
| work_keys_str_mv | AT schaapherderaf donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT kaisarm donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT mumfordl donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT robbm donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT johnsonr donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT dekokmjc donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT bemelmanfj donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT vandeweteringj donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT vanzuilenad donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT christiaansmhl donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT baasmc donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT nurmohamedas donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT bergersp donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT bastiaannete donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT devriesapj donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT sharplese donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT ploegrj donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation AT lindemanjhn donorcharacteristicsandtheirimpactonkidneytransplantationoutcomesresultsfromtwonationwideinstrumentalvariableanalysesbasedonoutcomesofdonorkidneypairsacceptedfortransplantation |