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

Authors
  • Kulkarni, Sanjay1
  • Wei, Guo2
  • Jiang, Wei3
  • Lopez, Licia A4
  • Parikh, Chirag R5
  • Hall, Isaac E6
  • 1 Section of Organ Transplantation and Immunology, Department of Surgery, Yale University School of Medicine, New Haven, CT.
  • 2 Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT.
  • 3 Yale University Graduate School of Arts and Sciences, New Haven, CT.
  • 4 Department of Pediatrics, Native American Research Internship, University of Utah School of Medicine, Salt Lake City, UT.
  • 5 Division of Nephrology, Department of Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD.
  • 6 Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT. Electronic address: [email protected]
Type
Published Article
Journal
American Journal of Kidney Diseases
Publisher
Elsevier
Publication Date
May 01, 2020
Volume
75
Issue
5
Pages
725–735
Identifiers
DOI: 10.1053/j.ajkd.2019.08.018
PMID: 31812448
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. Paired Organ Procurement and Transplantation Network analysis. Deceased-donor kidney pairs transplanted during 1990 to 2016. Right versus left kidney controlling for other significant factors. Delayed graft function (DGF), all-cause and death-censored graft failure, and mortality. 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. 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. Registry data, different transplant eras, reasons for kidney side unavailable. 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. Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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