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ORIGINAL RESEARCH article

Front. Nephrol.
Sec. Kidney Transplantation
Volume 4 - 2024 | doi: 10.3389/fneph.2024.1518791

Evaluating the Impact of Donor eGFR and HLA DR Mismatch on Graft Survival in Living Donor Kidney Transplants

Provisionally accepted
Pooja Budhiraja Pooja Budhiraja 1*Jesse D Schold Jesse D Schold 2*Rocio Lopez Moscoso Rocio Lopez Moscoso 2*Susana Arrigain Susana Arrigain 2*BRUCE KAPLAN BRUCE KAPLAN 2
  • 1 Mayo Clinic Arizona, Scottsdale, United States
  • 2 University of Colorado, Denver, Colorado, United States

The final, formatted version of the article will be published soon.

    Background. This study assesses the impact of Human Leukocyte Antigen (HLA) DR mismatch and donor-estimated Glomerular Filtration Rate (eGFR) on outcomes of living donor kidney transplantation (LDKT), especially relevant with the availability of multiple donors and paired kidney exchanges.Methods. Using SRTR data, we retrospectively analyzed graft survival in adult LDKT recipients transplanted between January 2013 and September 2022. Recipients with 0-DR mismatches were compared to those with 1-2 DR mismatches. Cox models assessed the association between donor eGFR and graft and patient survival, stratifying by a) DR mismatches, and b) DR mismatches and recipient age.Results. Among 44,080 recipients, 7,195 had 0-DR mismatches and 36,885 had 1-2 DR mismatches. Recipient mean age was 49.1 for 0-DR and 50.4 for 1-2 DR mismatch groups.Donor mean age was 43.1 and 43.8, with eGFR of 101.0 and 99.9 ml/min, respectively.Higher eGFR was associated with better graft survival. Stratified analyses showed higher donor eGFR levels reduced the risk of graft loss in cases with DR mismatch (p < 0.001) but not in cases without DR mismatch (p = 0.81). This effect was significant for recipients aged 18-39 and over 60. Similar results were observed for patient survival Conclusions. Higher donor eGFR was associated with lower risks of graft loss and patient death in the DR mismatch group but not the 0-DR mismatch group. These results emphasize the importance of considering both DR matching and donor kidney function, particularly for younger recipients to avoid sensitization for future transplants.

    Keywords: BMI, Body mass Index DDKT, deceased donor kidney transplantation eGFR, estimated glomerular filtration rate; HLA, human leukocyte antigens LDKT, Living donor kidney transplantation SRTR, Scientific Registry of Transplant Recipients

    Received: 29 Oct 2024; Accepted: 05 Dec 2024.

    Copyright: © 2024 Budhiraja, Schold, Lopez Moscoso, Arrigain and KAPLAN. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Pooja Budhiraja, Mayo Clinic Arizona, Scottsdale, United States
    Jesse D Schold, University of Colorado, Denver, CO 80203, Colorado, United States
    Rocio Lopez Moscoso, University of Colorado, Denver, CO 80203, Colorado, United States
    Susana Arrigain, University of Colorado, Denver, CO 80203, Colorado, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.