Nature Versus Nurture Study of Deceased-Donor Pairs in Kidney Transplantation

This study reports important donor effects on the risks of delayed graft function (DGF) and allograft failure in kidney transplant patients. It suggests opportunities to improve transplant outcomes and decrease the significant health and economic costs associated with transplant failure.

There are many known determinants of DGF and allograft failure, yet a limited effort has been made to evaluate the relative contribution of these risk factors by researching the variation in the response of recipients of kidneys from the same donor. This study examines this variation and is the first to study transplant center effect using common-donor recipients who underwent transplantation at the same time at different centers. Researchers examined 19,461 recipient pairs of the same donor’s kidneys using data from the U.S. Renal Data System.

Key Findings:

  • There was a significant correlation within pairs of kidney transplants from the same donor for the occurrence of DGF and allograft failure, suggesting that unmeasured donor factors (“nature”) contribute to transplant outcomes.
  • There was a transplant center effect (“nurture”) on DGF but not on allograft failure within the first three years after transplantation.
Both unmeasured donor characteristics and transplant center characteristics contribute to the risk for early allograft dysfunction; donor effects also contribute significantly to allograft failure. These findings suggest important opportunities to improve renal transplant outcomes and provide the most effective care.