The impact of deceased donor kidney risk significantly varies by recipient characteristics

Am J Transplant. 2013 Apr;13(4):1001-1011. doi: 10.1111/ajt.12154. Epub 2013 Feb 13.


As of May 2012, over 92 000 patients were awaiting a solitary kidney transplant in the United States and new waitlist registrations have been rising for over a decade. The decreasing availability of donor organs makes it imperative that organ allocation be as efficient and effective as possible. We performed a retrospective cohort study of adult recipients in the United States (n=109 392) using Scientific Registry of Transplant Recipients data. The primary aim was to evaluate the interaction of donor risk with recipient characteristics on posttransplant outcomes. Donor quality (based on kidney donor risk index [KDRI]) had significant interactions by race, primary diagnosis and age. The hazard of KDRI on overall graft loss in non-African Americans was 2.16 (95%CI 2.08-2.25) versus 1.85 (95%CI 1.75-1.95) in African Americans (p<0.0001), 2.16 (95%CI 2.08-2.24) in nondiabetics versus 1.84 (95%CI 1.74-1.94) in diabetics (p<0.0001), and 2.22 (95%CI 2.13-2.32) in recipients<60 years versus 1.83 (95%CI 1.74-1.92) in recipients≥60 (p<0.0001). The relative hazard for diabetics at KDRI=0.5 was 1.49 but at KDRI=2.0 the hazard was significantly attenuated to 1.17; among African Americans the respective risks were 1.50 and 1.17 and among recipients 60 and over, it was between 1.64 and 1.22. These findings are critical considerations for informed decision-making for transplant candidates.

MeSH terms

  • Adolescent
  • Adult
  • African Americans
  • Aged
  • Diabetes Mellitus / metabolism
  • Female
  • Graft Survival
  • Humans
  • Kidney Transplantation / methods*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Proportional Hazards Models
  • Registries
  • Renal Insufficiency / therapy*
  • Retrospective Studies
  • Risk Factors
  • Tissue Donors*
  • Tissue and Organ Procurement / methods*
  • Treatment Outcome
  • United States
  • Waiting Lists
  • Young Adult