Clinical and immunological predictors of receiving deceased donor kidney transplantation and waitlist dropout: a single-center study in Japan.

BACKGROUND

In Japan, where the annual number of deceased donor kidney transplantation (DDKT) is limited, candidates typically wait about 15 years for transplantation, and many leave the waitlist before a graft becomes available. We investigated baseline factors that influence the chance of DDKT and the risk of dropout to guide individualized care.

METHODS

This retrospective single-center study included 1,050 candidates who were actively listed for DDKT between 1997 and 2024. Kaplan-Meier curves described time to DDKT and dropout. Independent predictors were identified with multivariable Cox proportional hazards models, with a focused analysis of adult solitary kidney candidates (n = 842).

RESULTS

Transplant likelihood differed markedly across listing categories; only 8.6% of adult solitary kidney candidates received DDKT with a median wait of 18.7 years. In this group, HLA-A33 (HR:2.10, p = 0.0227), B62 (HR:2.20, p = 0.0127), B75 (HR:6.93, p = 0.0126), DR9 (HR:2.00, p = 0.0136) and DR15 (HR:2.47, p = 0.0005) increased the likelihood of DDKT, whereas prior transplantation trended toward lower likelihood (HR:0.14, p = 0.0530). Of 770 non-transplanted adult kidney candidates, 442 (57.4%) dropped out with a median of 8.4 years. Older age (HR:1.02 per year, p = 0.0017), diabetes mellitus as a primary renal disease (HR:1.39, p = 0.015) and peritoneal dialysis predicted dropout; hemodialysis was protective (HR:0.39, p < 0.0001).

CONCLUSIONS

Our findings suggest that baseline clinical variables and HLA profiles could stratify Japanese DDKT candidates by both their likelihood of receiving DDKT and their risk of dropping out. Applying this risk prediction into practice may support more personalized planning, including earlier consideration of living donor kidney transplantation or intensified management for high-risk patients.