Journal of nephrology · 2026
Association between donor albuminuria and the risk of graft failure in living-donor kidney transplantation: a retrospective cohort study.
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Yin Saifu, Dong Ling, Li Xing, Lin Tao
Аннотация
BACKGROUND: Kidney donors with marginal characteristics, including those presenting with albuminuria, are increasingly being accepted to alleviate organ shortages in transplantation. However, high-quality evidence establishing the association between pre-donation donor albuminuria and graft survival remains limited.
METHODS: In this retrospective cohort study, we analyzed data from living-donor kidney transplants performed between 2017 and 2023. Donor-recipient pairs were stratified based on pre-donation urinary albumin-to-creatinine ratio (uACR) into High-uACR (uACR ≥30 mg/g) and Low-uACR (uACR <30 mg/g) groups, consistent with Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The primary outcome was death-censored graft failure. Statistical analyses included Kaplan-Meier survival curves, multivariable Cox models, interaction and sensitivity analyses.
RESULTS: The study included 1674 living-donor kidney transplantation pairs, comprising 120 in the High-uACR group and 1554 in the Low-uACR group. Recipients in the High-uACR group exhibited a higher incidence of death-censored graft failure compared with those in the Low-uACR group (14.17% [17/120] vs. 2.19% [34/1554]; P < .001). After full adjustment, the High-uACR group was associated with a 2.13-fold increased risk of death-censored graft failure (adjusted hazard ratio [HR] = 2.13, 95% confidence interval [CI] = 1.02-4.46, P = .044). Interaction analysis revealed that the risk was amplified among recipients whose donors had both elevated uACR and hypertension/diabetes (HR = 4.73, 95% CI = 1.93-11.62, P = .001), compared to the reference group (Low-uACR donors without hypertension/diabetes). This association remained consistent across subgroup analyses stratified by donor pre-donation estimated glomerular filtration rate ([eGFR] ≥90 or <90 mL/min/1.73m2). Sensitivity analyses incorporating repeated uACR measurements, and competing risk analyses reported similar results.
CONCLUSION: Elevated uACR in living donors had moderate predictive power for graft failure after kidney transplantation. Further studies should be conducted to explore the clinical utility of uACR within a comprehensive risk assessment framework to improve recipient risk stratification and support informed decision-making in donor selection.
METHODS: In this retrospective cohort study, we analyzed data from living-donor kidney transplants performed between 2017 and 2023. Donor-recipient pairs were stratified based on pre-donation urinary albumin-to-creatinine ratio (uACR) into High-uACR (uACR ≥30 mg/g) and Low-uACR (uACR <30 mg/g) groups, consistent with Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The primary outcome was death-censored graft failure. Statistical analyses included Kaplan-Meier survival curves, multivariable Cox models, interaction and sensitivity analyses.
RESULTS: The study included 1674 living-donor kidney transplantation pairs, comprising 120 in the High-uACR group and 1554 in the Low-uACR group. Recipients in the High-uACR group exhibited a higher incidence of death-censored graft failure compared with those in the Low-uACR group (14.17% [17/120] vs. 2.19% [34/1554]; P < .001). After full adjustment, the High-uACR group was associated with a 2.13-fold increased risk of death-censored graft failure (adjusted hazard ratio [HR] = 2.13, 95% confidence interval [CI] = 1.02-4.46, P = .044). Interaction analysis revealed that the risk was amplified among recipients whose donors had both elevated uACR and hypertension/diabetes (HR = 4.73, 95% CI = 1.93-11.62, P = .001), compared to the reference group (Low-uACR donors without hypertension/diabetes). This association remained consistent across subgroup analyses stratified by donor pre-donation estimated glomerular filtration rate ([eGFR] ≥90 or <90 mL/min/1.73m2). Sensitivity analyses incorporating repeated uACR measurements, and competing risk analyses reported similar results.
CONCLUSION: Elevated uACR in living donors had moderate predictive power for graft failure after kidney transplantation. Further studies should be conducted to explore the clinical utility of uACR within a comprehensive risk assessment framework to improve recipient risk stratification and support informed decision-making in donor selection.