Rethinking procurement biopsy in donors with normal renal function: A barrier to kidney utilization without survival benefit

Table 5 Multivariable Cox proportional hazard model clustered by transplant center for death-censored graft survival in the propensity-matched cohort

Variables	HR	95%CI	P value
Biopsy performed	1.12	1.05-1.19	< 0.001
Donor
Kidney
Left	Reference
Right	0.99	0.94-1.06	0.94
Age, years	1.014	1.01-1.02	< 0.001
Male	1.02	0.94-1.09	0.66
Blood type
A	0.94	0.88-0.99	0.046
B	0.98	0.89-1.07	0.62
O	Reference
Height, cm	0.989	0.986-0.992	< 0.001
Weight, kg	0.998	0.986-1.001	0.07
eGFR terminal	0.997	0.996-0.998	< 0.001
History of hypertension	1.14	1.07-1.22	< 0.001
Diabetes mellitus	1.60	1.43-1.79	< 0.001
DCD	1.26	1.17-1.35	< 0.001
COD: CVA/stroke	1.12	1.04-1.20	< 0.001
Recipient
Age, years	0.975	0.972-0.977	< 0.001
Male	0.92	0.86-0.99	0.049
Height, cm	1.003	0.99-1.01	0.17
Weight, kg	1.005	1.003-1.007	< 0.001
Diagnosis
Autoimmune/systemic	Reference
Cystic/genetic	0.66	0.54-0.80	< 0.001
Diabetes mellitus	0.99	0.85-1.17	0.97
Glomerular	0.96	0.81-1.13	0.63
Other	0.97	0.81-1.15	0.69
Retransplant	0.90	0.76-1.07	0.22
Vascular/hypertensive	1.02	0.87-1.20	0.81
cPRA	1.002	1.001-1.003	< 0.001
Peripheral vascular disease	1.10	0.99-1.22	0.06
Dialysis groups
Preemptive	0.77	0.66-0.88	< 0.001
≤ 1 year	0.92	0.80-1.05	0.22
> 1 year ≤ 3 years	Reference
>3 years ≤ 5 years	1.06	0.97-1.17	0.19
> 5 years	1.10	1.01-1.20	0.03
Wait list, days	1.002	1.001-1.04	0.005
Transplant
Year groups
2014-2019	Reference
2020-2024	1.03	0.96-1.11	0.40
HLA mismatches
0	Reference
1-2	1.48	1.23-1.79	< 0.001
3-4	1.51	1.28-1.77	< 0.001
5-6	1.76	1.49-2.07	< 0.001
Cold ischemia time, hours	1.009	1.005-1.014	< 0.001
Machine perfusion	0.97	0.91-1.05	0.48
Distance between donor and recipients’ hospital by 100 miles	0.99	0.98-1.01	0.12
Shared organ
Local	Reference
Regional	1.06	0.97-1.17	0.20
National	1.20	1.07-1.35	< 0.001

Hazard ratios are from a Cox proportional hazard model clustered by transplant center adjusted for all donor, recipients and transplant covariables listed. The primary variable of interest was biopsy performed (yes vs no). eGFR: Epidermal growth factor receptor; DCD: Donor after circulatory death; COD: Cause of death; CVA: Cerebrovascular accident; cPRA: Calculated panel reactive antibody; HLA: Human leukocyte antigen; HR: Hazard ratio; CI: Confidence interval.