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. 2021 Jun;35(6):e14310.
doi: 10.1111/ctr.14310. Epub 2021 Apr 27.

The differential impact of size mismatch in live versus deceased donor kidney transplant

Amanda Vinson  1 , Tom Skinner  2 , Bryce Kiberd  3 , David Clark  1 , Karthik Tennankore  1
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The differential impact of size mismatch in live versus deceased donor kidney transplant

Amanda Vinson et al. Clin Transplant. 2021 Jun.

Abstract

Background: The impact of weight mismatch between donors and recipients (D-R) undergoing living-donor kidney transplant (LDKT) versus weight-matched deceased donor kidney transplant (DDKT) is not established.

Aim: To determine whether absolute weight mismatch between D-R affects graft survival following LDKT and how this relates to graft outcomes with DDKT when D-R are weight matched.

Materials & methods: We used multivariable Cox proportional hazards models and the Scientific Registry of Transplant Recipients to determine the association of weight-mismatched D-R (>50 kg, 30-50 kg or 10-30 kg ((D < R); (D > R) and <10 kg (D = R)) with death-censored graft failure in US LDKT recipients from 2006 to 2017. We also explored outcomes relative to weight-matched DDKT and finally, the impact of combined D-R weight-sex mismatch.

Results: In LDKT, the risk of graft loss was highest in the setting of D < R (HR 1.28, 95% CI 1.05-1.56 for >50 kg difference relative to D = R); however, this was still lower risk than weight-matched DDKT. D-R sex and combined weight-sex mismatch were only important for male recipients (HR 1.47, 95% CI 1.27-1.71 for a male recipient >30 kg larger than their female donor, relative to weight-matched male donor-male recipient). This remained superior to weight-sex-matched DDKT however.

Conclusion: D-R weight-sex mismatch is important in LDKT; however, graft survival remains superior to proceeding with matched DDKT. Optimizing D-R matching in LDKT could be facilitated through a national kidney-paired donation registry. LDKT weight-sex mismatch should not be deferred in favor of DDKT.

Keywords: allocation; deceased donor; kidney transplantation; living donor; size mismatch.

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