Kidney graft and recipient survival according to donor type: А retrospective single-centre cohort study

Abstract

Over the past decade, kidney transplant recipient survival has improved due to advances in immunosuppressive therapy protocols, surgical techniques, and post-transplant monitoring. However, chronic kidney transplant dysfunction (graft rejection) and death of recipients with functioning grafts remain among the major clinical challenges in modern transplant nephrology worldwide. The latter is particularly important for Ukraine, where kidney transplantation continues despite the war and its associated challenges.

The aim of this study was to assess kidney graft and recipient survival according to donor type and to assess the main causes of patient death and graft loss.

Methods.  This retrospective cohort study included 168 patients with stage 5 chronic kidney disease who underwent kidney transplantation between January 1, 2021, and September 1, 2024. After applying the inclusion criteria, data from 91 patients who underwent primary kidney transplantation were included in the final analysis. Fifty-three (58,24%) patients were male, and the mean age was 38.69 ± 10,77 years.

During follow-up, all deaths and their causes, as well as all cases of graft loss and their causes, were analyzed. The analysis was performed for the entire cohort and according to donor type: living related donor - Group 1 ( n=45/49,5%) or deceased - Group 2 (n=46/50,5% /).

For the survival analysis, the date of kidney transplantation was used as the starting point. Follow-up continued until death, loss to follow-up, or the end of the study (September 30, 2025), with a minimum follow-up period of 12 months.

Results. Cumulative recipient survival during the first year after transplantation was 84,2% in Group 1 vs 79,7% in Group 2 (P=0,5789), and 3-year survival was 81,4% vs 70,0% (log-rank: χ²= 1,4607; p=0,2268). During the follow-up period, 20 deaths were recorded. Regardless of donation type, the main causes of recipient death were infections (45,0%) and cardiovascular diseases (30,0%).

The overall 1-year graft survival was 80,3 ± 0,04%, and the 3-year - was 68,6 ± 0,06%.  Cumulative 1- and 3-year graft survival were 86,2% vs 74,4% (P=0.1599) and 74,6% vs 61,8% (P=0.1926), respectively of kidneys from living and deceased donors (log-rank: χ²=1,0891, df=1, p=0,2967).

Conclusions. No statistically significant differences in recipient or kidney graft survival were found according to donor type.