Infectious Complications in Living Donation Versus Donation After Brain Death Kidney Transplantation

Area of Science:

• Nephrology
• Transplantation immunology
• Infectious diseases

Background:

• Kidney transplantation is a vital treatment for end-stage renal disease.
• Living donor (LD) kidney transplantation generally offers superior outcomes compared to deceased donor (DBD) transplantation.
• The independent impact of LD donation on post-transplant infection risk remains uncertain.

Purpose of the Study:

• To investigate whether living donor (LD) status independently influences the risk of post-transplant infection in kidney transplant recipients (KT).
• To compare infection incidence between LD and DBD kidney transplant recipients.

Main Methods:

• A prospective observational cohort study included 503 kidney transplant recipients.
• Patients were categorized into LD (n=102) and DBD (n=401) groups.
• Propensity score (PS) modeling and multivariable Cox regression were used to assess donor type's association with infection risk, adjusting for confounding factors.

Main Results:

• The cumulative incidence of overall and bacterial infections was 58.6% and 43.7%, respectively.
• Crude analysis showed lower risks for overall and bacterial infections in LD recipients compared to DBD recipients (HR < 1, p < 0.01).
• After adjusting for baseline recipient characteristics using PS modeling and multivariable regression, donor type was not a significant independent predictor of overall or bacterial infection risk (adjusted HRs close to 1, p > 0.05).

Conclusions:

• Donor type does not independently affect post-transplant infection risk in kidney transplant recipients.
• Observed lower infection rates in LD recipients are likely attributable to favorable recipient and transplant-related characteristics, rather than donor-specific factors.
• These findings highlight the importance of recipient factors in managing post-transplant infection risk.