Risk factors for rejection after deceased donor kidney transplantation: a mono-institutional analysis of paired kidneys

Abstract Background Deceased donor kidney transplantation is an important therapeutic option for end-stage renal diseases. Adverse events including acute rejection after deceased donor kidney transplantation are not uncommon and result in poor transplant outcomes. Exploration of risk factors and patient stratification is increasingly significant to improve graft survival. This study aim to evaluate and identify the risk factors for treated rejection of patients after deceased donor kidney transplantation. Methods Clinical and immunological data of deceased donors and corresponding recipients between 2015 and 2018 in West China Hospital were retrospectively collected. The Kolmogorov-Smirnov test was used to indicate distribution of variables. Univariate comparisons of baseline characteristics were made with Chi-square, t and Mann-Whitney U tests. Logistic regression was constructed to analysis potential risk factors. Receiver operating characteristic curve and Jordan index were generated to determine optimal cut-off value for continuous variables. Results Data of 123 deceased donors and 246 recipients were obtained. The median (range) age was 41(4–62) years in recipients and 39 (1–65) years in donors. The recipients who died or suffered graft loss during the follow-up period were 8 (3.3%) and 12 (4.9%) respectively. After univariate analysis and subsequent multivariate analysis, some preoperative hemato-biochemical and transplantation-related parameters including uric acid (HR 2.132, 95%CI: 1.016–4.476, P = 0.045), platelet (HR 2.202, 95%CI:1.051–4.617, P = 0.037), absolute neutrophil count (HR 2.164, 95%CI:1.018–4.599, P = 0.045) and HLA-DQ mismatch (HR 2.197, 95%CI:1.119–4.317, P = 0.022) showed statistical significance and could be considered as independent predictors for treated rejection. Conclusions Including unexpected serum uric acid, several hemato-biochemical and transplantation-related parameters were found to be independent risk factors for rejection, which may contribute to stratify patients and develop personalized regimen in perioperative period.