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

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.