Renal failure · 2026
Recipient-driven and donor-driven determinants of delayed graft function in paired kidney transplantation: evidence from a Chinese cohort.
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Zhu Xuyuan, Zhang Yu, Chen Yuxiang, Li Shanda, Wang Kun, Li Tao, Ma Xiaojie, Jiang Hongtao
Аннотация
BACKGROUND: Delayed graft function (DGF) is a frequent complication of kidney transplantations. When both kidneys from a single deceased donor are transplanted into two recipients, DGF outcomes may be discordant, affecting only one recipient, or concordant, affecting both recipients. The factors underlying these within-donor differences, particularly in the Chinese population, remain poorly understood.
METHODS: We retrospectively analyzed 356 deceased-donor kidney transplants performed in our hospital between 2018 and 2022. We first examined recipient-specific factors associated with discordant DGF among paired recipients from the same donor. Second, we assessed donor factors associated with concordant DGF in both recipients.
RESULTS: In discordant pairs, multivariate regression identified recipient body mass index (BMI; odds ratio [OR] = 1.22, per unit changes; 95% CI 1.03-1.44; p = 0.019), dialysis duration (OR = 1.31, per years; 95% CI 1.01-1.69; p = 0.041), and number of HLA mismatches (OR = 1.47, 95% CI 1.06-2.02; p = 0.019) as independent predictors of DGF. Concordant analyses comparing donor pairs with DGF in both recipient and donor terminal creatinine (OR = 1.03, per mg/dL; 95% CI 1.01-1.05; p = 0.001), duration of donor hypertension (OR = 2.40, per years; 95% CI 1.52-3.81; p < 0.001), and donor warm ischemia time (OR = 1.67, per hours; 95% CI 1.15-2.44; p = 0.007) were independently associated with DGF in both recipients.
CONCLUSIONS: Among kidney recipients from the same donor, higher BMI, longer dialysis duration, and greater HLA mismatch independently predicted DGF when outcomes were discordant. Conversely, donor-related factors, higher terminal creatinine, longer hypertension duration, and prolonged warm ischemia drove DGF in both recipients.
METHODS: We retrospectively analyzed 356 deceased-donor kidney transplants performed in our hospital between 2018 and 2022. We first examined recipient-specific factors associated with discordant DGF among paired recipients from the same donor. Second, we assessed donor factors associated with concordant DGF in both recipients.
RESULTS: In discordant pairs, multivariate regression identified recipient body mass index (BMI; odds ratio [OR] = 1.22, per unit changes; 95% CI 1.03-1.44; p = 0.019), dialysis duration (OR = 1.31, per years; 95% CI 1.01-1.69; p = 0.041), and number of HLA mismatches (OR = 1.47, 95% CI 1.06-2.02; p = 0.019) as independent predictors of DGF. Concordant analyses comparing donor pairs with DGF in both recipient and donor terminal creatinine (OR = 1.03, per mg/dL; 95% CI 1.01-1.05; p = 0.001), duration of donor hypertension (OR = 2.40, per years; 95% CI 1.52-3.81; p < 0.001), and donor warm ischemia time (OR = 1.67, per hours; 95% CI 1.15-2.44; p = 0.007) were independently associated with DGF in both recipients.
CONCLUSIONS: Among kidney recipients from the same donor, higher BMI, longer dialysis duration, and greater HLA mismatch independently predicted DGF when outcomes were discordant. Conversely, donor-related factors, higher terminal creatinine, longer hypertension duration, and prolonged warm ischemia drove DGF in both recipients.