Association Between Donor-Recipient Biological Relationship
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The findings of the JAMA study suggest that kidney donors who are related to their recipients may share genetic or socioenvironmental predispositions to kidney disease that shorten allograft longevity.

The research examines the association between donor-recipient biological relationship and allograft survival after living donor kidney transplants.

This retrospective cohort study used Organ Procurement and Transplantation Network data on US adult living donor kidney transplants (n?=?86?154), excluding cases in which recipients previously received a kidney transplant (n?=?10?342) or key data were missing (n?=?2832).

Among the 72980 transplant donors and recipients included in the study, 43174 donors and recipients were biologically related and 29806 were unrelated.

--Donors related to their recipients were younger and less likely to be female or White.

--Recipients related to their donors were younger, more likely to be female, and less likely to have cystic kidney disease.

--Related pairs had fewer HLA mismatches overall. After adjustment for HLA mismatches, donor and recipient characteristics, and transplant era, the donor-recipient biological relationship was associated with higher death-censored allograft failure.

--When stratified by a primary disease, this association persisted only for recipients without cystic kidney disease. When stratified by donor race, this association persisted only for transplants from African American donors.

In this cohort study, living donor kidney transplants from donors biologically related to their recipients had higher rates of allograft failure than transplants from donors unrelated to their recipients after HLA matching was accounted for.