Infectious Complications in Living Donation Versus Donation After Brain Death Kidney Transplantation.

BACKGROUND

Kidney transplantation from living donors (LDs) offers benefits over donation after brain death (DBD). Whether LD independently protects against infection incidence remains unclear.

METHODS

We compared posttransplant infection between LD (n = 102) and DBD (n = 401) groups in a prospective observational cohort of 503 KT recipients at a tertiary-care center. Crude and adjusted associations between donor type and infection risk were assessed using propensity score (PS) modeling and multivariable Cox regression.

RESULTS

Cumulative incidence rates of overall and bacterial infection were 58.6% and 43.7%, respectively. Compared to DBD recipients, LD patients had lower crude risks for overall (hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.39-0.74; p-value < 0.001) and bacterial infection (HR: 0.59; 95% CI: 0.41-0.87; p-value = 0.007). In PS-based models, donor type was no longer significant for overall (PS-adjusted HR: 0.78; 95% CI: 0.52-1.18; p-value = 0.244) or bacterial infection (PS-adjusted HR: 0.94, 95% CI: 0.59-1.50; p-value = 0.802). Similar effect modification appeared for secondary outcomes and adjusted multivariable models.

CONCLUSION

Donor type did not independently influence posttransplant infection risk after adjustment for baseline recipient factors. Lower infection incidence in LD recipients may reflect favorable recipient- and transplant-related characteristics rather than donor-specific factors.