RATIONALE & OBJECTIVE Risk factors for kidney failure are the basis of live kidney donor candidate evaluation. We quantified risk for end-stage kidney disease (ESKD) by the biological relationship of the donor to the recipient, a risk factor that is not addressed by current clinical practice guidelines. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS A cohort of 143,750 US kidney donors between 1987 and 2017. EXPOSURE Biological relationship of donor and recipient. OUTCOME ESKD. Donors' records were linked to national dialysis and transplantation registries to ascertain development of the outcome. ANALYTIC APPROACH Donors were observed over a median of 12 (interquartile range, 6-18; maximum, 30) years. Survival analysis methods that account for the competing risk for death were used. RESULTS Risk for ESKD varied by orders of magnitude across donor-recipient relationship categories. For Asian donors, risks compared with unrelated donors were 259.4-fold greater for identical twins (95% CI, 19.5-3445.6), 4.7-fold greater for full siblings (95% CI, 0.5-41.0), 3.5-fold greater for offspring (95% CI, 0.6-39.5), 1.0 for parents, and 1.0 for half-sibling or other biological relatives. For black donors, risks were 22.5-fold greater for identical twin donors (95% CI, 4.7-107.0), 4.1-fold for full siblings (95% CI, 2.1-7.8), 2.7-fold for offspring (95% CI, 1.4-5.4), 3.1-fold for parents (95% CI, 1.4-6.8), and 1.3-fold for half-sibling or other biological relatives (95% CI, 0.5-3.3). For white donors, risks were 3.5-fold greater for identical twin donors (95% CI, 0.5-25.3), 2.0-fold for full siblings (95% CI, 1.4-2.8), 1.4-fold for offspring (95% CI, 0.9-2.3), 2.9-fold for parents (95% CI, 2.0-4.1), and 0.8-fold for half-sibling or other biological relatives (95% CI, 0.3-1.6). LIMITATIONS Insufficient sample size in some race and relationship groups. Absence of data for family history of kidney disease for donors biologically unrelated to their recipients. CONCLUSIONS Marked differences in risk for ESKD across types of donor-recipient relationship were observed for Asian, black, and white donors. These findings warrant further validation with more robust data to better inform clinical practice guidelines.

中文翻译：

---

不同种族群体的活体肾脏捐献者与接收者的关系和ESKD风险。

理由和目的肾衰竭的危险因素是活体肾脏供体候选者评估的基础。我们通过供体与受体之间的生物学关系量化了终末期肾脏疾病（ESKD）的风险，目前的临床实践指南并未解决这一风险因素。研究设计回顾性队列研究。背景与参与者1987年至2017年间，共有143,750名美国肾脏捐赠者。暴露捐赠者与接受者的生物学关系。成绩预告。捐助者的记录与国家透析和移植登记处有关，以确定结果的发展。分析方法在12年（四分位间距为6-18；最大为30）年中观察到了供体。使用了占死亡竞争风险的生存分析方法。结果ESKD的风险在捐赠者与接受者之间的关系类别中因数量级而异。对于亚洲捐献者来说，同卵双胞胎的风险比无关的捐献者高259.4倍（95％CI，19.5-3445.6），同胞兄弟姐妹的风险高4.7倍（95％CI，0.5-41.0），后代的风险高3.5倍。 （95％CI，0.6-39.5），父母为1.0，同胞或其他生物亲戚为1.0。对于黑人捐献者，同卵双胞胎捐献者的风险高出22.5倍（95％CI，4.7-107.0），同胞兄弟姐妹的风险高出4.1倍（95％CI，2.1-7.8），后代的风险则高出2.7倍（95％CI， 1.4-5.4），父母的3.1倍（95％CI，1.4-6.8），半兄弟姐妹或其他生物学亲戚的1.3倍（95％CI，0.5-3.3）。对于白人捐赠者，同卵双生供者的风险要高3.5倍（95％CI，0.5-25.3），对同胞兄弟姐妹的风险要高2.0倍（95％CI，1.4-2.8），1。后代的4倍（95％CI，0.9-2.3），父母的2.9倍（95％CI，2.0-4.1），半兄弟姐妹或其他生物亲属的0.8倍（95％CI，0.3-1.6） ）。限制在某些种族和人际关系群体中样本数量不足。缺少与接收者在生物学上无关的捐献者肾脏疾病家族史的数据。结论在亚洲，黑人和白人捐赠者中，在不同类型的捐赠者与受赠者关系中，ESKD风险存在显着差异。这些发现需要用更可靠的数据进行进一步验证，以更好地指导临床实践指南。缺少与接收者在生物学上无关的捐献者的肾脏疾病家族史的数据。结论在亚洲，黑人和白人捐赠者中，在不同类型的捐赠者与受赠者关系中，ESKD风险存在显着差异。这些发现需要用更可靠的数据进行进一步验证，以更好地指导临床实践指南。缺少与接收者在生物学上无关的捐献者的肾脏疾病家族史的数据。结论在亚洲，黑人和白人捐赠者中，在不同类型的捐赠者与受赠者关系中，ESKD风险存在显着差异。这些发现需要用更可靠的数据进行进一步验证，以更好地指导临床实践指南。