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A propensity score-weighted comparison of outcomes between living and standard criteria deceased donor kidney transplant recipients

Yohanna S, Naylor KL, McArthur E, Lam NN, Austin PC, Habbous S, McCallum MK, Ordon M, Knoll GA, Kim JS, Garg AX. Transplantation. 2020; 104(11):e317-e27. Epub 2020 Jun 1. DOI:

Background — Consider a theoretical situation in which 2 patients with similar baseline characteristics receive a kidney transplant on the same day: 1 from a standard criteria deceased donor, the other from a living donor. Which kidney transplant will last longer?

Methods — We conducted a population-based cohort study using linked administrative healthcare databases from Ontario, Canada from January 1, 2005 to March 31, 2014 to evaluate several posttransplant outcomes in individuals who received a kidney transplant from a standard criteria deceased donor (n=1523) or from a living donor (n=1373). We used propensity-score weighting using overlap weights, a novel weighting method that emphasizes the population of recipients with the most overlap in baseline characteristics.

Results — Compared to recipients of a living donor, the rate of all-cause graft failure was not statistically higher for recipients of a standard criteria deceased donor (hazard ratio 1.1, 95% confidence interval [CI]: 0.8, 1.6). Recipients of a standard criteria deceased donor, compared to recipients of a living donor had a higher rate of delayed graft function (23.6% vs. 18.7%, odds ratio 1.3, 95% CI: 1.0, 1.6) and a longer length of stay for the kidney transplant surgery (mean difference 1.7 days, 95% CI: 0.5, 3.0).

Conclusion — After accounting for many important donor and recipient factors, we failed to observe a large difference in the risk of all-cause graft failure for recipients of a standard criteria deceased versus living donor. Some estimates were imprecise which meant we could not rule out the presence of smaller clinically important effects.