Donor Phosphorus Levels and Recipient Outcomes in Living-Donor Kidney Transplantation

Background and objectives In living-donor kidney transplantation, various donor factors, including gender, age, and baseline kidney function, predict allograft function and recipient outcomes after transplantation. Because higher phosphorus is predictive of vascular injury in healthy adults, the effect of donor phosphorus levels on recipient renal function after transplantation was investigated. Design, setting, participants, and measurements Phosphorus levels in 241 living donors were analyzed from a 7-year period, and recipient renal function and acute rejection at 1 year posttransplantation were examined controlling for other influencing factors, including multiple donor variables, HLA matching, and acute rejection. Results Female and African-American donors had significantly higher phosphorus levels predonation. By multivariable analysis, higher donor phosphorus correlated with higher recipient serum creatinine (slope = 0.087, 95% confidence interval [CI]: 0.004 to 0.169, P = 0.041) and lower recipient estimated GFR (slope = -4.321, 95% CI: -8.165 to -0.476, P = 0.028) at 12 months. Higher donor phosphorus also displayed an independent correlation with biopsy-proven acute rejection and delayed or slow graft function after transplantation. Conclusions In a cohort of living kidney donors, higher donor phosphorus correlated with female gender and African-American ethnicity and was an independent risk factor for early allograft dysfunction after living-donor kidney transplantation. Clin J Am Soc Nephrol 6: 1179-1184, 2011. doi: 10.2215/CJN.03220410