Nature versus Nurture in Deceased Donor Kidney Transplant Pairs

A recent paper in the most recent issue of JASN by Louvar et al asks the "nature versus nurture" question of deceased donor kidney transplants. Using data from the US Renal Data System (USRDS), the investigators looked at over 19,000 recipient pairs who received kidneys from the same deceased donor. Their goal was to determine the relative importance of donor characteristics ("nature") versus transplant center characteristics ("nurture") on deceased-donor kidney transplant outcomes.

To be brief, they the study had two major findings. First (the "nature" component), a recipient was more than twice as likely to develop delayed graft function when the recipient of the contralateral kidney also developed delayed graft finding. Not surprising--if one kidney sucks, the other one is likely to suck. Second (the "nurture" component), for pairs transplanted within the same center, there was an additional 42% risk for delayed graft function compared to pairs transplanted at different centers. That is, certain transplant centers are associated with a greater chance of delayed graft function than others. On this latter point, it's important to point out that some transplant centers tend to take higher-risk patients (e.g., desensitization protocols, ABO mismatches, 3rd- or 4th- transplants, high PRAs, etc) than others, so it may not be totally fair to use such center-specific data as "rankings" of transplant care quality.