Recipient-driven and donor-driven determinants of delayed graft function in paired kidney transplantation: evidence from a Chinese cohort

Background Delayed graft function (DGF) is a frequent complication of kidney transplantations. When both kidneys from a single deceased donor are transplanted into two recipients, DGF outcomes may be discordant, affecting only one recipient, or concordant, affecting both recipients. The factors underlying these within-donor differences, particularly in the Chinese population, remain poorly understood.Methods We retrospectively analyzed 356 deceased-donor kidney transplants performed in our hospital between 2018 and 2022. We first examined recipient-specific factors associated with discordant DGF among paired recipients from the same donor. Second, we assessed donor factors associated with concordant DGF in both recipients.Results In discordant pairs, multivariate regression identified recipient body mass index (BMI; odds ratio [OR] = 1.22, per unit changes; 95% CI 1.03–1.44; p = 0.019), dialysis duration (OR = 1.31, per years; 95% CI 1.01–1.69; p = 0.041), and number of HLA mismatches (OR = 1.47, 95% CI 1.06–2.02; p = 0.019) as independent predictors of DGF. Concordant analyses comparing donor pairs with DGF in both recipient and donor terminal creatinine (OR = 1.03, per mg/dL; 95% CI 1.01–1.05; p = 0.001), duration of donor hypertension (OR = 2.40, per years; 95% CI 1.52–3.81; p < 0.001), and donor warm ischemia time (OR = 1.67, per hours; 95% CI 1.15–2.44; p = 0.007) were independently associated with DGF in both recipients.Conclusions Among kidney recipients from the same donor, higher BMI, longer dialysis duration, and greater HLA mismatch independently predicted DGF when outcomes were discordant. Conversely, donor-related factors, higher terminal creatinine, longer hypertension duration, and prolonged warm ischemia drove DGF in both recipients.