Comparison of outcomes after living and deceased donor kidney transplantation: UK national cohort study.
Using nearly 11 000 UK transplants, researchers adjusted for differences between patients and still found that living donor kidneys survived better than deceased donor kidneys, adding about four months of extra graft survival over seven years. The advantage held across all the patient groups examined.
Background
Most kidneys for transplantation come from deceased donors, though healthy living individuals may also donate. Living donor transplants generally show better outcomes, but it has been unclear whether this reflects an inherent benefit of a living donor kidney or differences in donor and recipient characteristics.
Study design
The study analysed 10 915 UK kidney-only transplants implanted between 2010 and 2021, using inverse probability of treatment weighting based on propensity scores to adjust for baseline imbalances. The mean treatment effect was estimated from differences in survival probabilities and restricted mean survival time using weighted competing risks models, with all-cause death without graft failure treated as a competing risk.
Key findings
Living donor kidney transplantation was associated with a 6.03% (95% c.i. 4.71% to 7.35%) lower 5-year risk of graft failure compared with deceased donor kidney transplantation. Over 7 years, living donor recipients experienced an additional 0.36 (95% c.i. 0.29 to 0.43) years of graft survival, and benefits persisted across clinically relevant subgroups.
Clinical implications
The authors conclude that the findings support promoting living donor programmes while simultaneously identifying opportunities to enhance deceased donor transplantation outcomes.
Category
Transplant
Source
British Journal of Surgery
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