Recipient Outcomes Following Transplantation of Allografts From Live Kidney Donors Who Subsequently Developed End-Stage Renal Disease

Am J Transplant. 2016 Dec;16(12):3532-3539. doi: 10.1111/ajt.13869. Epub 2016 Jun 27.


Live kidney donors have an increased risk of end-stage renal disease (ESRD) compared with nondonors; however, it is unknown whether undetected, subclinical kidney disease exists at donation that subsequently contributes to this risk. To indirectly test this hypothesis, the authors followed the donated kidneys, by comparing the outcomes of 257 recipients whose donors subsequently developed ESRD with a matched cohort whose donors remained ESRD free. The compared recipients were matched on donor (age, sex, race/ethnicity, donor-recipient relationship), transplant (HLA mismatch, peak panel-reactive antibody, previous transplantation, year of transplantation), and recipient (age, sex, race/ethnicity, body mass index, cause of ESRD, and time on dialysis) risk factors. Median recipient follow-up was 12.5 years (interquartile range 7.4-17.9, maximum 20 years). Recipients of allografts from donors who developed ESRD had increased death-censored graft loss (74% versus 56% at 20 years; adjusted hazard ratio [aHR] 1.7; 95% confidence interval [CI] 1.5-2.0; p < 0.001) and mortality (61% versus 46% at 20 years; aHR 1.5; 95% CI 1.2-1.8; p < 0.001) compared with matched recipients of allografts from donors who did not develop ESRD. This association was similar among related, spousal, and unrelated nonspousal donors. These findings support a novel view of the mechanisms underlying donor ESRD: that of pre-donation kidney disease. However, biopsy data may be required to confirm this hypothesis.

Keywords: clinical research/practice; donors and donation: living; kidney transplantation/nephrology; kidney transplantation: living donor.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Allografts
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Graft Survival
  • Humans
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / mortality*
  • Kidney Function Tests
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / mortality*
  • Living Donors*
  • Male
  • Middle Aged
  • Nephrectomy / adverse effects
  • Nephrectomy / mortality*
  • Postoperative Complications
  • Prognosis
  • Risk Factors
  • Survival Rate
  • Tissue and Organ Harvesting / adverse effects*
  • Young Adult