title: Maternal compared with paternal donor kidneys are associated with poorer graft outcomes after kidney transplantation.
abstract: Noninherited maternal human leukocyte antigens may be less detrimental on allograft outcomes after kidney transplantation compared with noninherited paternal antigens, but this association in the era of modern immunosuppression remains unknown. Here we determine the association between parental donor kidneys, acute rejection, and graft failure in primary live-donor parental kidney transplant recipients using data from the Australia and New Zealand Dialysis and Transplant Registry between 1997 and 2012. Of the 1139 recipients followed for a median of 7.2 years (8588 person-years), 652 received kidneys from maternal donors. Compared with paternal donor kidneys, maternal donor kidneys were associated with a significantly increased risk of acute rejection (adjusted odds ratio 1.54; 95% confidence interval [CI], 1.14-2.07) and significant overall graft loss. The latter was confined to recipients who have experienced acute rejection (adjusted hazard ratio 1.60; 95%CI, 1.05-2.43) but not in those who did not experience acute rejection. Thus, our study suggests that recipients of maternal donor kidneys have a greater risk of rejection and graft loss. Hence, clinicians and patients should be cognizant of this association when determining which of the 2 parental donors is most suitable for transplantation.
authors.affiliation: Department of Renal Medicine, Sir Charles Gairdner Hospital, Western Australia, Australia; Australia and New Zealand Dialysis and Transplant Registry, South Australia, Australia. Electronic address: wai.lim@health.wa.gov.au.
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
authors.affiliation: Australia and New Zealand Dialysis and Transplant Registry, South Australia, Australia; Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, South Australia, Australia; University of Adelaide, South Australia, Australia.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: McDonald
authors.affiliation: Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, South Australia, Australia; University of Adelaide, South Australia, Australia.
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Coates
authors.affiliation: Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Australia and New Zealand Dialysis and Transplant Registry, South Australia, Australia; Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, South Australia, Australia; University of Adelaide, South Australia, Australia.
authors.forename: Graeme R
authors.initials: GR
authors.lastname: Russ
authors.affiliation: Australia and New Zealand Dialysis and Transplant Registry, South Australia, Australia; Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia; Sydney School of Public Health, University of Sydney, New South Wales, Australia.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001315:Australia; D002648:Child; D046148:Donor Selection; D005220:Fathers; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods*; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009035:Mothers; D009520:New Zealand; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: ANZDATA; HLA mismatches; epidemiology; parental donors; registry; rejection