Isabel Rodríguez-Goncer, Gabriel Motoa, Esther González, Francisco López-Medrano, Tamara Ruiz-Merlo, Hernando Trujillo, Ana Hernández, Fernando Caravaca-Fontán, José Enrique Ruiz-Cabello, Rafael San-Juan, Camille N Kotton, Amado Andrés, José María Aguado, Mario Fernández-Ruiz
Donor type did not independently influence posttransplant infection risk after adjustment for baseline recipient factors. Lower infection incidence in LD recipients may reflect favorable recipient- and transplant-related characteristics rather than donor-specific factors.
BACKGROUND: Kidney transplantation from living donors (LDs) offers benefits over donation after brain death (DBD). Whether LD independently protects against infection incidence remains unclear.
METHODS: We compared posttransplant infection between LD (n = 102) and DBD (n = 401) groups in a prospective observational cohort of 503 KT recipients at a tertiary-care center. Crude and adjusted associations between donor type and infection risk were assessed using propensity score (PS) modeling and multivariable Cox regression.
RESULTS: Cumulative incidence rates of overall and bacterial infection were 58.6% and 43.7%, respectively. Compared to DBD recipients, LD patients had lower crude risks for overall (hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.39-0.74; p-value < 0.001) and bacterial infection (HR: 0.59; 95% CI: 0.41-0.87; p-value = 0.007). In PS-based models, donor type was no longer significant for overall (PS-adjusted HR: 0.78; 95% CI: 0.52-1.18; p-value = 0.244) or bacterial infection (PS-adjusted HR: 0.94, 95% CI: 0.59-1.50; p-value = 0.802). Similar effect modification appeared for secondary outcomes and adjusted multivariable models.
CONCLUSION: Donor type did not independently influence posttransplant infection risk after adjustment for baseline recipient factors. Lower infection incidence in LD recipients may reflect favorable recipient- and transplant-related characteristics rather than donor-specific factors.