Original Investigation
Outcomes From Right Versus Left Deceased-Donor Kidney Transplants: A US National Cohort Study

https://doi.org/10.1053/j.ajkd.2019.08.018Get rights and content

Rationale & Objective

There may be important transplant-related differences between right and left kidneys, including logistical/surgical considerations about vessel length for the right compared to the left kidney from the same donor. Because US centers choose between the right and left kidney when their recipient is ranked higher on a “match-run,” we sought to determine whether deceased-donor right kidneys have had worse posttransplantation outcomes than left kidneys.

Study Design

Paired Organ Procurement and Transplantation Network analysis.

Setting & Participants

Deceased-donor kidney pairs transplanted during 1990 to 2016.

Exposure

Right versus left kidney controlling for other significant factors.

Outcomes

Delayed graft function (DGF), all-cause and death-censored graft failure, and mortality.

Analytical Approach

Multivariable conditional logistic regression for DGF; proportional hazards models (conditional on same donor) for failure/mortality with right kidneys (operationalized as 6-month time-varying coefficients) adjusting for DGF and other confounders.

Results

87,112 recipient pairs shared the following donor characteristics: mean age of 41 ± 14 years, 60% males, and 11% with cardiac death. Recipient characteristics were numerically similar by donor kidney side but with some statistical differences given the sample size. Right kidneys had slightly longer cold ischemia time. DGF occurred more often for right kidneys (28% vs 25.8%; P < 0.001; adjusted OR, 1.15 [95% CI, 1.12-1.17]). The adjusted hazard ratio (aHR) for all-cause graft failure with right kidneys within 6 months was 1.07 (95% CI, 1.03-1.11), and was 0.99 (95% CI, 0.97-1.01) thereafter. The aHRs for death-censored graft failure with right kidneys before and after 6 months were 1.11 (95% CI, 1.06-1.16) and 0.96 (95% CI, 0.93-0.99), respectively; the corresonding aHRs for mortality were 0.99 (95% CI, 0.93-1.04) and 1.00 (95% CI, 0.98-1.03), respectively.

Limitations

Registry data, different transplant eras, reasons for kidney side unavailable.

Conclusions

There is modest association for transplantation of right kidneys with DGF and graft loss within the first 6 months, which is lost beyond this time point. These findings do not support the use of laterality of deceased-donor kidneys as an important factor in organ acceptance decisions.

Section snippets

Study Cohort

This study used OPTN data as of March 2018. The OPTN system includes data for all US donors, wait-listed candidates, and transplant recipients, submitted by OPTN members and has been described elsewhere.15 The Health Resources and Services Administration, US Department of Health and Human Services, provides oversight to the activities of the OPTN contractor that supplies data to researchers; currently the United Network for Organ Sharing (UNOS). The study was administratively reviewed by the

Cohort

Figure 1 shows cohort assembly, resulting in 87,112 deceased-donor kidney recipient pairs. Mean donor age was 41 ± 14 years, 60% were male, 74% were white, 11% were DCD, and mean KDPI was 46% ± 26% (Table 1). Recipient characteristics were numerically similar by donor kidney side, though several comparisons were statistically different given the large sample size (Table 2). In terms of potentially clinically meaningful differences, right-sided kidney recipients were less likely to have received

Discussion

In addition to summary metrics such as the KDRI when deciding to accept or decline individual deceased-donor kidney offers, transplantation providers consider many donor factors that are not incorporated into current clinical scores. Such factors include additional medical history, trends in pre-procurement kidney function, biopsy information, and especially kidney anatomy in relation to blood vessels.

In this large database study, we evaluated paired deceased-donor kidney transplantations to

Article Information

Authors’ Full Names and Academic Degrees

Sanjay Kulkarni, MD, Guo Wei, MS, Wei Jiang, MS, Licia A. Lopez, BS, Chirag R. Parikh, MD, PhD, and Isaac E. Hall, MD, MS.

Authors’ Contributions

Research idea and study design: IEH; statistical analysis: WJ, GW; data analysis/interpretation: SK, CRP, IEH; literature review: LAL, IEH; supervision or mentorship: CRP, IEH. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or

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    © 2019 by the National Kidney Foundation, Inc.