How good is a living donor? Systematic review and meta-analysis of the effect of donor demographics on post kidney transplant outcomes.

Content Provider	Europe PMC
Author	Bellini, Maria Irene Nozdrin, Mikhail Pengel, Liset Knight, Simon Papalois, Vassilios
Abstract	Background and AimsLiving donor kidneys are considered the best quality organs. In the attempt to expand the donor pool, the donor’s age, sex and body mass index (BMI) might be considered as potential determinants of the kidney transplant outcomes, and thus guide recipient selection. We aimed to investigate the effects of donor demographics on kidney function, graft and recipient survival, delayed graft function (DGF) and acute rejection (AR).MethodsSystematic review and meta-analysis. EMBASE, MEDLINE, Web of Science, BIOSIS, CABI, SciELO and Cochrane were searched using algorithms. NHBLI tools were used for risk of bias assessment. Mean difference (MD), standardized mean difference (SMD), and risk ratio (RR) were calculated in Revman 5.4ResultsAltogether, 5129 studies were identified by the search algorithm; 47 studies met the inclusion criteria and were analyzed. No significant difference in recipient 1-year survival was found between recipients of donors aged < 50 vs donors aged > 50 (RR = 0.65 95% CI: 0.1–4.1), and recipients of donors aged < 60 vs donors aged > 60 (RR = 0.81 95% CI: 0.3–2.3). Graft survival was significantly higher in recipients of grafts from donors aged < 60. Risk of AR (RR = 0.62 95% CI: 0.5–0.8) and DGF (RR = 0.28 95% CI: 0.1–0.9) were significantly lower in recipients of grafts from donors aged < 60. One-year serum creatinine was significantly lower in recipients from donors aged < 60 years compared to donors aged > 60 years (MD = 0.3 mg/dl 95% CI: 0.1–0.9), although there was high heterogeneity. Recipients of grafts from male donors had lower 1-year serum creatinine (MD = 0.12 mg/dl 95% CI: 0.2–0.1) and higher eGFR compared to recipients of female donors (p < 0.00001). Donor obesity increased the incidence of delayed graft function but not acute rejection (RR = 0.66 95% CI: 0.32–1.34).ConclusionsOlder donor age was associated with worse post-transplant outcomes and recipients of male donors had better 1-year eGFR. Donor obesity affects the incidence of delayed graft function, but not the incidence of acute rejection in recipients.Graphical AbstractSupplementary InformationThe online version contains supplementary material available at 10.1007/s40620-021-01231-7.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC8995249&blobtype=pdf
ISSN	11218428
Journal	Journal of Nephrology [J Nephrol]
Volume Number	35
DOI	10.1007/s40620-021-01231-7
PubMed Central reference number	PMC8995249
Issue Number	3
PubMed reference number	35072936
e-ISSN	17246059
Language	English
Publisher	Springer International Publishing
Publisher Date	2022-01-24
Publisher Place	Gewerbestrasse 11, Cham, Ch 6330, Switzerland
Access Restriction	Open
Rights License	Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. © The Author(s) 2022
Subject Keyword	Living donation Donor’s demographics Graft outcomes Kidney transplantation
Content Type	Text
Resource Type	Article
Subject	Nephrology