Machine perfusion distribution across clinical phenotypes in kidney transplantation: A national cohort study using unsupervised clustering

doi:10.5500/wjt.121821

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Transplant. Sep 18, 2026; 16(3): 121821
Published online Sep 18, 2026. doi: 10.5500/wjt.121821

Table 1 Features selected for modelling and their missingness percentage before imputation

Features	Missing data full cohort (n = 15904) (%)	Missing data MP subgroup (n = 544) (%)
Recipient BMI	19.98	22.61
Serum creatinine (umol/L) 12-month post-transplant	19.54	13.42
Serum creatinine (umol/L) 3-month post-transplant	15.79	13.79
Recipient deprivation group	16.17	31.25
Predniscolone/predniscone immunosuppression 3 months post-transplant	16.10	13.24
Type of dialysis at transplant	15.17	16.36
Donor allergy	12.09	10.85
Initial graft function	8.53	9.93
Donor cause of death	5.29	4.60
Recipient positive CMV status	4.89	5.33
Donor family history of diabetes	4.52	4.41
Recipient ethnicity	4.44	4.04
Donor positive EBV status	4.21	2.76
Donor creatinine at retrieval	3.41	5.88
Donor ethnicity	3.40	2.21
Donor history of drug abuse	2.50	3.68
Donor history of cardiac disease	2.18	4.23
Donor history of UTI	1.88	2.57
Donor hypertension	1.62	2.02
Donor positive toxo status	1.37	1.10
Perfusate used	1.08	0.74
Donor history of diabetes	0.91	1.29
Perfusion quality	0.74	2.94
Donor positive CMV status	0.59	1.10
Graft status	0.57	0
Follow-up time	0.55	0
Donor BMI	0.53	0.37
Donor smoker	0.52	0.55
Dialysis status at registration	0.35	0.18
Cold ischemia time	0.22	0.37
Allocation matchability score	0.18	0
Waiting list time	0.17	0.18
Dialysis status at transplant	0.13	0
Kidney used by local centre	0.10	0
Donor ABO blood group	0.04	0
Recipient sex	0.04	0.18
Highly sensitised status flag	0.03	0
Donor homozygous at DR locus	0.01	0
Donor homozygous at B locus	0.01	0
Donor homozygous at A locus	0.01	0
HLA mismatch group	0.01	0
Recipient homozygous at B locus	0.01	0
Recipient homozygous at DR locus	0.01	0
Recipient homozygous at A locus	0.01	0
Number of mismatches at DR locus	0.01	0
Number of mismatches at A locus	0.01	0
Number of mismatches at B locus	0.01	0
Recipient age	0	0
Donor sex	0	0
Donor type	0	0
Recipient diabetes	0	0
Donor age	0	0
Recipient ABO blood group	0	0
Donor organ	0	0
Transplant year	0	0
Machine perfusion type	0	0

BMI: Body mass index; UTI: Urinary tract infection; HLA: Human leukocyte antigen; EBV: Epstein-Barr virus; CMV: Cytomegalovirus.

Full Size Table

Table 2 Full cohort descriptive baseline characteristics, n (%)

Characteristic	All (n = 15904)	Cluster 1 (n = 2797)	Cluster 2 (n = 2826)	Cluster 3 (n = 2370)	Cluster 4 (n = 1854)	Cluster 5 (n = 2402)	Cluster 6 (n = 3655)
Recipient age	53.6 (13.3)	47.6 (13.6)	61.4 (9.7)	49.2 (13.4)	55.8 (12.0)	45.7 (12.2)	59.3 (10.3)
Recipient BMI	27.4 (4.8)	27.2 (5.0)	28.8 (4.5)	27.3 (4.9)	27.6 (4.6)	26.0 (4.7)	27.6 (4.5)
Recipient sex
Female	5888 (37.0)	1106 (39.5)	663 (23.5)	856 (36.1)	742 (40.0)	1249 (52.0)	1272 (34.8)
Male	10010 (62.9)	1690 (60.4)	2163 (76.5)	1514 (63.9)	1112 (60.0)	1149 (47.8)	2382 (65.2)
Recipient ABO blood group
A	6220 (39.1)	1121 (40.1)	1095 (38.7)	991 (41.8)	651 (35.1)	902 (37.6)	1460 (39.9)
AB	816 (5.1)	179 (6.4)	159 (5.6)	93 (3.9)	90 (4.9)	139 (5.8)	156 (4.3)
B	2071 (13.0)	346 (12.4)	346 (12.2)	227 (9.6)	351 (18.9)	341 (14.2)	460 (12.6)
O	6797 (42.7)	1151 (41.2)	1226 (43.4)	1059 (44.7)	762 (41.1)	1020 (42.5)	1579 (43.2)
Recipient ethnicity
Asian	3026 (19.0)	484 (17.3)	435 (15.4)	238 (10.0)	525 (28.3)	628 (26.1)	716 (19.6)
Black	1684 (10.6)	315 (11.3)	303 (10.7)	128 (5.4)	309 (16.7)	263 (10.9)	366 (10.0)
White	10488 (65.9)	1859 (66.5)	1963 (69.5)	1938 (81.8)	887 (47.8)	1408 (58.6)	2433 (66.6)
Recipient diabetes	2205 (13.9)	267 (9.5)	683 (24.2)	217 (9.2)	337 (18.2)	140 (5.8)	561 (15.3)
Recipient positive CMV status	8478 (53.3)	1417 (50.7)	1476 (52.2)	1034 (43.6)	1198 (64.6)	1308 (54.5)	2045 (56.0)
Dialysis status at registration
Hemo	7790 (49.0)	1467 (52.4)	1633 (57.8)	888 (37.5)	992 (53.5)	1075 (44.8)	1735 (47.5)
Not	5514 (34.7)	840 (30.0)	711 (25.2)	1132 (47.8)	535 (28.9)	940 (39.1)	1356 (37.1)
Peritoneal	2545 (16.0)	477 (17.1)	476 (16.8)	342 (14.4)	318 (17.2)	380 (15.8)	552 (15.1)
Dialysis at transplant	13412 (84.3)	2430 (86.9)	2518 (89.1)	1735 (73.2)	1620 (87.4)	2024 (84.3)	3085 (84.4)
Type of dialysis at transplant
Hemo	10218 (64.2)	1851 (66.2)	1964 (69.5)	1228 (51.8)	1254 (67.6)	1530 (63.7)	2391 (65.4)
Not	79 (0.5)	35 (1.3)	13 (0.5)	8 (0.3)	7 (0.4)	2 (0.1)	14 (0.4)
Peritoneal	3195 (20.1)	579 (20.7)	555 (19.6)	507 (21.4)	366 (19.7)	494 (20.6)	694 (19.0)
Donor organ
Left kidney	7476 (47.0)	1197 (42.8)	1396 (49.4)	1067 (45.0)	928 (50.1)	978 (40.7)	1910 (52.3)
Right kidney	8428 (53.0)	1600 (57.2)	1430 (50.6)	1303 (55.0)	926 (49.9)	1424 (59.3)	1745 (47.7)
Highly sensitised status flag	1041 (6.5)	140 (5.0)	69 (2.4)	143 (6.0)	259 (14.0)	247 (10.3)	183 (5.0)
Waiting list time	2.6 (1.9)	2.9 (2.0)	2.9 (1.8)	1.6 (1.4)	2.8 (2.2)	2.6 (2.1)	2.6 (1.8)
Recipient deprivation group
Quartile 1 most deprived	3288 (20.7)	448 (16.0)	688 (24.3)	557 (23.5)	320 (17.3)	386 (16.1)	889 (24.3)
Quartile 2 second most deprived	3303 (20.8)	536 (19.2)	613 (21.7)	533 (22.5)	363 (19.6)	437 (18.2)	821 (22.5)
Quartile 3 second least deprived	3365 (21.2)	657 (23.5)	593 (21.0)	399 (16.8)	427 (23.0)	555 (23.1)	734 (20.1)
Quartile 4 least deprived	3377 (21.2)	661 (23.6)	498 (17.6)	423 (17.8)	467 (25.2)	639 (26.6)	689 (18.9)
Donor age	52.6 (14.0)	44.1 (12.3)	62.1 (9.0)	52.4 (12.6)	51.0 (14.0)	41.0 (12.6)	60.3 (9.7)
Donor BMI	27.4 (5.4)	26.3 (5.1)	28.8 (5.7)	27.4 (5.3)	27.0 (5.3)	26.0 (4.9)	28.2 (5.4)
Donor sex
Female	6983 (43.9)	1086 (38.8)	1313 (46.5)	1162 (49.0)	744 (40.1)	908 (37.8)	1770 (48.4)
Male	8921 (56.1)	1711 (61.2)	1513 (53.5)	1208 (51.0)	1110 (59.9)	1494 (62.2)	1885 (51.6)
Donor ABO blood group
A	6430 (40.4)	1166 (41.7)	1153 (40.8)	1026 (43.3)	644 (34.7)	937 (39.0)	1504 (41.1)
AB	523 (3.3)	118 (4.2)	96 (3.4)	41 (1.7)	58 (3.1)	99 (4.1)	111 (3.0)
B	1609 (10.1)	276 (9.9)	285 (10.1)	146 (6.2)	261 (14.1)	265 (11.0)	376 (10.3)
O	7335 (46.1)	1234 (44.1)	1291 (45.7)	1157 (48.8)	888 (47.9)	1101 (45.8)	1664 (45.5)
Donor ethnicity
Asian	457 (2.9)	79 (2.8)	96 (3.4)	44 (1.9)	59 (3.2)	68 (2.8)	111 (3.0)
Black	199 (1.3)	37 (1.3)	32 (1.1)	28 (1.2)	29 (1.6)	34 (1.4)	39 (1.1)
White	14707 (92.5)	2545 (91.0)	2597 (91.9)	2259 (95.3)	1688 (91.0)	2193 (91.3)	3425 (93.7)
Donor positive CMV status	7699 (48.4)	1198 (42.8)	1468 (51.9)	1157 (48.8)	837 (45.1)	1084 (45.1)	1955 (53.5)
Donor positive EBV status	14349 (90.2)	2561 (91.6)	2624 (92.9)	2131 (89.9)	1676 (90.4)	2073 (86.3)	3284 (89.8)
Donor positive toxoplasmosis status	2505 (15.8)	326 (11.7)	522 (18.5)	375 (15.8)	279 (15.0)	328 (13.7)	675 (18.5)
Donor cardiac disease	1966 (12.4)	132 (4.7)	719 (25.4)	229 (9.7)	170 (9.2)	79 (3.3)	637 (17.4)
Donor diabetes	1262 (7.9)	85 (3.0)	432 (15.3)	168 (7.1)	130 (7.0)	67 (2.8)	380 (10.4)
Donor family history of diabetes	4889 (30.7)	998 (35.7)	801 (28.3)	703 (29.7)	617 (33.3)	833 (34.7)	937 (25.6)
Donor history of drug abuse	3073 (19.3)	1380 (49.3)	236 (8.4)	163 (6.9)	609 (32.8)	586 (24.4)	99 (2.7)
Donor hypertension	4738 (29.8)	253 (9.0)	1596 (56.5)	663 (28.0)	461 (24.9)	153 (6.4)	1612 (44.1)
Donor smoker	9722 (61.1)	2143 (76.6)	1704 (60.3)	1205 (50.8)	1323 (71.4)	1548 (64.4)	1799 (49.2)
Donor history of UTI	896 (5.6)	142 (5.1)	186 (6.6)	119 (5.0)	102 (5.5)	111 (4.6)	236 (6.5)
Donor allergy	5382 (33.8)	1097 (39.2)	1295 (45.8)	622 (26.2)	739 (39.9)	517 (21.5)	1112 (30.4)
Donor creatinine at retrieval	0.3 (0.5)	0.3 (0.5)	0.2 (0.4)	0.3 (0.5)	0.3 (0.5)	0.4 (0.5)	0.3 (0.4)
Donor type
DBD	8900 (56.0)	1772 (63.4)	1349 (47.7)	1649 (69.6)	932 (50.3)	1520 (63.3)	1678 (45.9)
DCD	7004 (44.0)	1025 (36.6)	1477 (52.3)	721 (30.4)	922 (49.7)	882 (36.7)	1977 (54.1)
Donor cause of death
Neurological	13832 (87.0)	2439 (87.2)	2534 (89.7)	2073 (87.5)	1617 (87.2)	1935 (80.6)	3234 (88.5)
Other	1231 (7.7)	172 (6.1)	117 (4.1)	199 (8.4)	133 (7.2)	343 (14.3)	267 (7.3)
Cold ischemia time	13.8 (4.8)	14.0 (5.0)	14.1 (4.7)	13.2 (4.6)	14.3 (4.9)	13.7 (4.9)	13.7 (4.8)
Perfusate used
HTK	979 (6.2)	324 (11.6)	381 (13.5)	11 (0.5)	253 (13.6)	2 (0.1)	8 (0.2)
Marshalls	2536 (15.9)	265 (9.5)	489 (17.3)	352 (14.9)	244 (13.2)	305 (12.7)	881 (24.1)
Wisconsin	12217 (76.8)	2180 (77.9)	1915 (67.8)	1984 (83.7)	1326 (71.5)	2074 (86.3)	2738 (74.9)
Perfusion quality
Fair	1031 (6.5)	128 (4.6)	223 (7.9)	142 (6.0)	141 (7.6)	129 (5.4)	268 (7.3)
Good	14139 (88.9)	2583 (92.3)	2461 (87.1)	2128 (89.8)	1628 (87.8)	2177 (90.6)	3162 (86.5)
Poor	616 (3.9)	77 (2.8)	126 (4.5)	78 (3.3)	75 (4.0)	78 (3.2)	182 (5.0)
Machine perfusion type
HMP	359 (2.3)	13 (0.5)	27 (1.0)	72 (3.0)	13 (0.7)	71 (3.0)	163 (4.5)
NMP	185 (1.2)	27 (1.0)	31 (1.1)	20 (0.8)	26 (1.4)	29 (1.2)	52 (1.4)
SCS	15360 (96.6)	2757 (98.6)	2768 (97.9)	2278 (96.1)	1815 (97.9)	2302 (95.8)	3440 (94.1)
Donor homozygous at A locus	2501 (15.7)	419 (15.0)	419 (14.8)	635 (26.8)	218 (11.8)	320 (13.3)	490 (13.4)
Donor homozygous at B locus	1366 (8.6)	250 (8.9)	239 (8.5)	407 (17.2)	41 (2.2)	177 (7.4)	252 (6.9)
Donor homozygous at DR locus	1850 (11.6)	272 (9.7)	286 (10.1)	548 (23.1)	69 (3.7)	289 (12.0)	386 (10.6)
Recipient homozygous at A locus	2781 (17.5)	397 (14.2)	396 (14.0)	235 (9.9)	443 (23.9)	586 (24.4)	724 (19.8)
Recipient homozygous at B locus	1793 (11.3)	166 (5.9)	167 (5.9)	87 (3.7)	476 (25.7)	440 (18.3)	457 (12.5)
Recipient homozygous at DR locus	2502 (15.7)	167 (6.0)	184 (6.5)	109 (4.6)	633 (34.1)	650 (27.1)	759 (20.8)
Number of mismatches at A locus
One	7784 (48.9)	1474 (52.7)	1498 (53.0)	955 (40.3)	864 (46.6)	1162 (48.4)	1831 (50.1)
Two	5598 (35.2)	937 (33.5)	966 (34.2)	321 (13.5)	835 (45.0)	1051 (43.8)	1488 (40.7)
Zero	2521 (15.9)	386 (13.8)	362 (12.8)	1094 (46.2)	155 (8.4)	188 (7.8)	336 (9.2)
Number of mismatches at B locus
One	10801 (67.9)	2032 (72.6)	2040 (72.2)	1338 (56.5)	501 (27.0)	2015 (83.9)	2875 (78.7)
Two	2824 (17.8)	211 (7.5)	389 (13.8)	0 (0.0)	1331 (71.8)	286 (11.9)	607 (16.6)
Zero	2278 (14.3)	554 (19.8)	397 (14.0)	1032 (43.5)	22 (1.2)	100 (4.2)	173 (4.7)
Number of mismatches at DR locus
One	8205 (51.6)	1553 (55.5)	1804 (63.8)	38 (1.6)	844 (45.5)	1346 (56.0)	2620 (71.7)
Two	1276 (8.0)	15 (0.5)	111 (3.9)	0 (0.0)	986 (53.2)	45 (1.9)	119 (3.3)
Zero	6422 (40.4)	1229 (43.9)	911 (32.2)	2332 (98.4)	24 (1.3)	1010 (42.0)	916 (25.1)
HLA mismatch group
(0 DR and 2B) OR (1 DR and 1/0 B)	8319 (52.3)	1706 (61.0)	1911 (67.6)	38 (1.6)	289 (15.6)	1499 (62.4)	2876 (78.7)
(1 DR and 2 B) OR (2 DR)	2207 (13.9)	43 (1.5)	233 (8.2)	0 (0.0)	1565 (84.4)	98 (4.1)	268 (7.3)
0 DR and 1/0 B	4494 (28.3)	1011 (36.1)	662 (23.4)	1506 (63.5)	0 (0.0)	804 (33.5)	511 (14.0)
0 Mismatches	883 (5.6)	37 (1.3)	20 (0.7)	826 (34.9)	0 (0.0)	0 (0.0)	0 (0.0)
Initial graft function
DGF	3352 (21.1)	466 (16.7)	855 (30.3)	370 (15.6)	420 (22.7)	345 (14.4)	896 (24.5)
Immediate	10826 (68.1)	1968 (70.4)	1571 (55.6)	1774 (74.9)	1187 (64.0)	1858 (77.4)	2468 (67.5)
PNF	369 (2.3)	69 (2.5)	134 (4.7)	20 (0.8)	50 (2.7)	17 (0.7)	79 (2.2)
Predniscolone/predniscone immunosuppression 3 months post-transplant
No	3843 (24.2)	553 (19.8)	605 (21.4)	674 (28.4)	354 (19.1)	610 (25.4)	1047 (28.6)
Yes	9500 (59.7)	1703 (60.9)	1605 (56.8)	1453 (61.3)	1081 (58.3)	1531 (63.7)	2127 (58.2)
Graft status
Died functioning	1861 (11.7)	146 (5.2)	362 (12.8)	245 (10.3)	193 (10.4)	175 (7.3)	740 (20.2)
Died unknown function	45 (0.3)	3 (0.1)	16 (0.6)	3 (0.1)	6 (0.3)	5 (0.2)	12 (0.3)
Failed	2030 (12.8)	214 (7.7)	543 (19.2)	309 (13.0)	181 (9.8)	211 (8.8)	572 (15.6)
Functioning	11878 (74.7)	2419 (86.5)	1879 (66.5)	1804 (76.1)	1456 (78.5)	2002 (83.3)	2318 (63.4)
Allocation matchability score	6.5 (2.8)	4.9 (2.7)	4.7 (2.7)	5.6 (2.5)	8.3 (2.1)	8.2 (1.8)	7.7 (2.1)
Serum creatinine (umol/L) at 3 months post-transplant	152.3 (63.4)	128.3 (40.2)	209.8 (80.7)	150.1 (54.4)	141.5 (54.7)	110.4 (30.6)	163.0 (55.5)
Serum creatinine (umol/L) at 12 months post-transplant	143.6 (58.8)	121.9 (39.9)	195.5 (75.9)	144.8 (53.7)	134.2 (51.8)	107.2 (30.8)	155.6 (53.0)
Follow-up time	4.2 (2.9)	2.5 (1.7)	2.0 (1.6)	6.1 (2.6)	2.4 (1.9)	6.6 (2.4)	5.3 (2.6)
Transplant year
2014	1484 (9.3)	9 (0.3)	34 (1.2)	420 (17.7)	21 (1.1)	462 (19.2)	538 (14.7)
2015	1475 (9.3)	17 (0.6)	49 (1.7)	389 (16.4)	32 (1.7)	421 (17.5)	567 (15.5)
2016	1630 (10.2)	35 (1.3)	88 (3.1)	446 (18.8)	47 (2.5)	403 (16.8)	611 (16.7)
2017	1785 (11.2)	85 (3.0)	145 (5.1)	445 (18.8)	54 (2.9)	421 (17.5)	635 (17.4)
2018	1920 (12.1)	225 (8.0)	249 (8.8)	318 (13.4)	114 (6.1)	390 (16.2)	624 (17.1)
2019	1870 (11.8)	355 (12.7)	329 (11.6)	213 (9.0)	312 (16.8)	198 (8.2)	463 (12.7)
2020	1462 (9.2)	501 (17.9)	354 (12.5)	65 (2.7)	339 (18.3)	71 (3.0)	132 (3.6)
2021	1577 (9.9)	594 (21.2)	548 (19.4)	43 (1.8)	308 (16.6)	23 (1.0)	61 (1.7)
2022	1420 (8.9)	548 (19.6)	531 (18.8)	22 (0.9)	288 (15.5)	11 (0.5)	20 (0.5)
2023	745 (4.7)	290 (10.4)	309 (10.9)	8 (0.3)	133 (7.2)	1 (0.0)	4 (0.1)
2024	536 (3.4)	138 (4.9)	190 (6.7)	1 (0.0)	206 (11.1)	1 (0.0)	0 (0.0)
Kidney used by local centre
No	12057 (75.8)	2472 (88.4)	2420 (85.6)	1764 (74.4)	1579 (85.2)	1644 (68.4)	2178 (59.6)
Yes	3831 (24.1)	324 (11.6)	403 (14.3)	604 (25.5)	275 (14.8)	755 (31.4)	1470 (40.2)

BMI: Body mass index; UTI: Urinary tract infection; DBD: Donation after brain death; DCD: Donation after cardiac death; HTK: Histidine-tryptophan-ketoglutarate solution; HMP: Hypothermic machine perfusion; CMV: Cytomegalovirus; NMP: Normothermic machine perfusion; EBV: Epstein-Barr virus; HLA: Human leukocyte antigen; DGF: Delayed graft function; PNF: Primary non-function.

Full Size Table

Table 3 Machine perfusion subgroup descriptive baseline characteristics, n (%)

Characteristic	All (n = 544)	Cluster 1 (n = 41)	Cluster 2 (n = 59)	Cluster 3 (n = 93)	Cluster 4 (n = 36)	Cluster 5 (n = 97)	Cluster 6 (n = 218)
Recipient age	55.9 (12.1)	49.5 (12.0)	62.9 (9.5)	52.9 (12.4)	53.2 (12.2)	48.9 (12.7)	60.2 (9.5)
Recipient BMI	27.7 (5.0)	26.3 (4.7)	29.1 (4.7)	28.1 (4.5)	28.2 (6.3)	26.5 (4.9)	28.0 (5.0)
Recipient sex
Female	183 (33.6)	12 (29.3)	10 (16.9)	33 (35.5)	17 (47.2)	42 (43.3)	69 (31.7)
Male	360 (66.2)	29 (70.7)	49 (83.1)	60 (64.5)	19 (52.8)	55 (56.7)	148 (67.9)
Recipient ABO blood group
A	214 (39.3)	17 (41.5)	29 (49.2)	38 (40.9)	15 (41.7)	37 (38.1)	78 (35.8)
AB	21 (3.9)	3 (7.3)	1 (1.7)	4 (4.3)	1 (2.8)	5 (5.2)	7 (3.2)
B	69 (12.7)	4 (9.8)	7 (11.9)	4 (4.3)	6 (16.7)	11 (11.3)	37 (17.0)
O	240 (44.1)	17 (41.5)	22 (37.3)	47 (50.5)	14 (38.9)	44 (45.4)	96 (44.0)
Recipient ethnicity
Asian	68 (12.5)	5 (12.2)	7 (11.9)	6 (6.5)	10 (27.8)	14 (14.4)	26 (11.9)
Black	34 (6.2)	5 (12.2)	6 (10.2)	1 (1.1)	5 (13.9)	5 (5.2)	12 (5.5)
White	420 (77.2)	28 (68.3)	44 (74.6)	85 (91.4)	16 (44.4)	74 (76.3)	173 (79.4)
Recipient diabetes	74 (13.6)	4 (9.8)	12 (20.3)	6 (6.5)	6 (16.7)	4 (4.1)	42 (19.3)
Recipient positive CMV serostatus	260 (47.8)	17 (41.5)	28 (47.5)	33 (35.5)	24 (66.7)	52 (53.6)	106 (48.6)
Dialysis status at registration
Hemodialysis	251 (46.1)	20 (48.8)	36 (61.0)	37 (39.8)	27 (75.0)	31 (32.0)	100 (45.9)
Not	211 (38.8)	12 (29.3)	20 (33.9)	43 (46.2)	7 (19.4)	45 (46.4)	84 (38.5)
Peritoneal	81 (14.9)	9 (22.0)	3 (5.1)	12 (12.9)	2 (5.6)	21 (21.6)	34 (15.6)
Dialysis at transplant	454 (83.5)	36 (87.8)	53 (89.8)	75 (80.6)	34 (94.4)	81 (83.5)	175 (80.3)
Type of dialysis at transplant
Hemodialysis	345 (63.4)	25 (61.0)	43 (72.9)	56 (60.2)	31 (86.1)	60 (61.9)	130 (59.6)
Not	1 (0.2)	1 (2.4)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Peritoneal	109 (20.0)	11 (26.8)	10 (16.9)	19 (20.4)	3 (8.3)	21 (21.6)	45 (20.6)
Donor organ
Left kidney	293 (53.9)	20 (48.8)	30 (50.8)	50 (53.8)	15 (41.7)	44 (45.4)	134 (61.5)
Right kidney	251 (46.1)	21 (51.2)	29 (49.2)	43 (46.2)	21 (58.3)	53 (54.6)	84 (38.5)
Highly sensitised status flag	26 (4.8)	2 (4.9)	1 (1.7)	4 (4.3)	4 (11.1)	10 (10.3)	5 (2.3)
Waiting list time	2.0 (1.5)	2.6 (1.7)	2.6 (1.8)	1.6 (1.2)	2.4 (1.6)	2.0 (1.6)	1.9 (1.3)
Recipient deprivation group
Quartile 1 most deprived	105 (19.3)	11 (26.8)	11 (18.6)	16 (17.2)	6 (16.7)	18 (18.6)	43 (19.7)
Quartile 2 second most deprived	82 (15.1)	4 (9.8)	15 (25.4)	10 (10.8)	6 (16.7)	9 (9.3)	38 (17.4)
Quartile 3 second least deprived	99 (18.2)	8 (19.5)	7 (11.9)	14 (15.1)	11 (30.6)	19 (19.6)	40 (18.3)
Quartile 4 least deprived	88 (16.2)	10 (24.4)	6 (10.2)	14 (15.1)	6 (16.7)	21 (21.6)	31 (14.2)
Donor age	54.7 (13.0)	46.1 (11.9)	60.2 (8.5)	54.9 (12.4)	51.9 (13.9)	41.9 (12.2)	61.0 (8.7)
Donor BMI	27.0 (5.3)	24.9 (4.3)	28.5 (5.9)	26.9 (5.2)	26.4 (4.9)	25.3 (4.3)	27.8 (5.6)
Donor sex
Female	224 (41.2)	11 (26.8)	23 (39.0)	47 (50.5)	15 (41.7)	24 (24.7)	104 (47.7)
Male	320 (58.8)	30 (73.2)	36 (61.0)	46 (49.5)	21 (58.3)	73 (75.3)	114 (52.3)
Donor ABO blood group
A	221 (40.6)	18 (43.9)	29 (49.2)	39 (41.9)	14 (38.9)	40 (41.2)	81 (37.2)
AB	12 (2.2)	2 (4.9)	1 (1.7)	2 (2.2)	1 (2.8)	2 (2.1)	4 (1.8)
B	58 (10.7)	4 (9.8)	7 (11.9)	3 (3.2)	6 (16.7)	8 (8.2)	30 (13.8)
O	253 (46.5)	17 (41.5)	22 (37.3)	49 (52.7)	15 (41.7)	47 (48.5)	103 (47.2)
Donor ethnicity
Asian	2 (0.4)	0 (0.0)	1 (1.7)	0 (0.0)	0 (0.0)	0 (0.0)	1 (0.5)
Black	1 (0.2)	1 (2.4)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
White	529 (97.2)	36 (87.8)	57 (96.6)	93 (100.0)	36 (100.0)	95 (97.9)	212 (97.2)
Donor positive CMV status	250 (46.0)	16 (39.0)	25 (42.4)	37 (39.8)	19 (52.8)	44 (45.4)	109 (50.0)
Donor positive EBV status	483 (88.8)	33 (80.5)	54 (91.5)	82 (88.2)	32 (88.9)	86 (88.7)	196 (89.9)
Donor positive toxoplasmosis status	98 (18.0)	8 (19.5)	9 (15.3)	18 (19.4)	4 (11.1)	13 (13.4)	46 (21.1)
Donor cardiac disease	64 (11.8)	5 (12.2)	18 (30.5)	7 (7.5)	4 (11.1)	4 (4.1)	26 (11.9)
Donor diabetes	28 (5.1)	0 (0.0)	10 (16.9)	2 (2.2)	2 (5.6)	3 (3.1)	11 (5.0)
Donor family history of diabetes	151 (27.8)	10 (24.4)	23 (39.0)	20 (21.5)	10 (27.8)	27 (27.8)	61 (28.0)
Donor history of drug abuse	74 (13.6)	20 (48.8)	4 (6.8)	3 (3.2)	13 (36.1)	26 (26.8)	8 (3.7)
Donor hypertension	148 (27.2)	2 (4.9)	36 (61.0)	15 (16.1)	8 (22.2)	5 (5.2)	82 (37.6)
Donor smoker	306 (56.2)	29 (70.7)	39 (66.1)	50 (53.8)	26 (72.2)	68 (70.1)	94 (43.1)
Donor history of UTI	37 (6.8)	3 (7.3)	7 (11.9)	4 (4.3)	4 (11.1)	3 (3.1)	16 (7.3)
Donor allergy	162 (29.8)	16 (39.0)	29 (49.2)	26 (28.0)	18 (50.0)	15 (15.5)	58 (26.6)
Donor creatinine at retrieval	0.3 (0.5)	0.3 (0.5)	0.1 (0.4)	0.3 (0.4)	0.2 (0.4)	0.4 (0.5)	0.3 (0.5)
Donor type
DBD	33 (6.1)	3 (7.3)	3 (5.1)	6 (6.5)	5 (13.9)	5 (5.2)	11 (5.0)
DCD	511 (93.9)	38 (92.7)	56 (94.9)	87 (93.5)	31 (86.1)	92 (94.8)	207 (95.0)
Donor cause of death
Neurological	470 (86.4)	35 (85.4)	57 (96.6)	73 (78.5)	32 (88.9)	84 (86.6)	189 (86.7)
Other	49 (9.0)	1 (2.4)	0 (0.0)	15 (16.1)	2 (5.6)	11 (11.3)	20 (9.2)
Cold ischemia time	13.4 (4.7)	13.7 (4.7)	15.2 (4.6)	12.2 (4.3)	16.2 (4.7)	12.9 (4.6)	13.1 (4.7)
Perfusate used
HTK	10 (1.8)	1 (2.4)	2 (3.4)	2 (2.2)	3 (8.3)	1 (1.0)	1 (0.5)
Marshalls	112 (20.6)	3 (7.3)	14 (23.7)	21 (22.6)	2 (5.6)	15 (15.5)	57 (26.1)
Wisconsin	418 (76.8)	37 (90.2)	42 (71.2)	69 (74.2)	31 (86.1)	81 (83.5)	158 (72.5)
Perfusion quality
Fair	63 (11.6)	1 (2.4)	8 (13.6)	13 (14.0)	3 (8.3)	16 (16.5)	22 (10.1)
Good	424 (77.9)	36 (87.8)	44 (74.6)	70 (75.3)	31 (86.1)	72 (74.2)	171 (78.4)
Poor	41 (7.5)	4 (9.8)	7 (11.9)	7 (7.5)	2 (5.6)	5 (5.2)	16 (7.3)
Machine perfusion type
HMP	359 (66.0)	13 (31.7)	29 (49.2)	73 (78.5)	12 (33.3)	71 (73.2)	161 (73.9)
NMP	185 (34.0)	28 (68.3)	30 (50.8)	20 (21.5)	24 (66.7)	26 (26.8)	57 (26.1)
Donor homozygous at A locus	104 (19.1)	8 (19.5)	14 (23.7)	21 (22.6)	4 (11.1)	17 (17.5)	40 (18.3)
Donor homozygous at B locus	54 (9.9)	4 (9.8)	5 (8.5)	12 (12.9)	0 (0.0)	15 (15.5)	18 (8.3)
Donor homozygous at DR locus	88 (16.2)	5 (12.2)	7 (11.9)	34 (36.6)	1 (2.8)	17 (17.5)	24 (11.0)
Recipient homozygous at A locus	103 (18.9)	8 (19.5)	8 (13.6)	6 (6.5)	8 (22.2)	23 (23.7)	50 (22.9)
Recipient homozygous at B locus	67 (12.3)	2 (4.9)	6 (10.2)	5 (5.4)	9 (25.0)	14 (14.4)	31 (14.2)
Recipient homozygous at DR locus	94 (17.3)	1 (2.4)	3 (5.1)	6 (6.5)	13 (36.1)	23 (23.7)	48 (22.0)
Number of mismatches at A locus
One	306 (56.2)	25 (61.0)	31 (52.5)	61 (65.6)	20 (55.6)	52 (53.6)	117 (53.7)
Two	156 (28.7)	7 (17.1)	19 (32.2)	8 (8.6)	13 (36.1)	35 (36.1)	74 (33.9)
Zero	82 (15.1)	9 (22.0)	9 (15.3)	24 (25.8)	3 (8.3)	10 (10.3)	27 (12.4)
Number of mismatches at B locus
One	388 (71.3)	28 (68.3)	39 (66.1)	69 (74.2)	12 (33.3)	81 (83.5)	159 (72.9)
Two	97 (17.8)	3 (7.3)	13 (22.0)	0 (0.0)	24 (66.7)	13 (13.4)	44 (20.2)
Zero	59 (10.8)	10 (24.4)	7 (11.9)	24 (25.8)	0 (0.0)	3 (3.1)	15 (6.9)
Number of mismatches at DR locus
One	309 (56.8)	31 (75.6)	42 (71.2)	1 (1.1)	22 (61.1)	60 (61.9)	153 (70.2)
Two	37 (6.8)	0 (0.0)	3 (5.1)	0 (0.0)	14 (38.9)	4 (4.1)	16 (7.3)
Zero	198 (36.4)	10 (24.4)	14 (23.7)	92 (98.9)	0 (0.0)	33 (34.0)	49 (22.5)
HLA mismatch group
(0 DR and 2B) OR (1 DR and 1/0 B)	301 (55.3)	32 (78.0)	43 (72.9)	1 (1.1)	10 (27.8)	62 (63.9)	153 (70.2)
(1 DR and 2 B) OR (2 DR)	78 (14.3)	1 (2.4)	9 (15.3)	0 (0.0)	26 (72.2)	8 (8.2)	34 (15.6)
0 DR and 1/0 B	149 (27.4)	8 (19.5)	7 (11.9)	76 (81.7)	0 (0.0)	27 (27.8)	31 (14.2)
0 mismatches	16 (2.9)	0 (0.0)	0 (0.0)	16 (17.2)	0 (0.0)	0 (0.0)	0 (0.0)
Initial graft function
DGF	108 (19.9)	5 (12.2)	18 (30.5)	16 (17.2)	9 (25.0)	16 (16.5)	44 (20.2)
Immediate	370 (68.0)	31 (75.6)	29 (49.2)	66 (71.0)	25 (69.4)	73 (75.3)	146 (67.0)
PNF	12 (2.2)	2 (4.9)	3 (5.1)	0 (0.0)	0 (0.0)	0 (0.0)	7 (3.2)
Predniscolone/predniscone immunosuppression 3 months post-transplant
No	150 (27.6)	9 (22.0)	8 (13.6)	30 (32.3)	11 (30.6)	27 (27.8)	65 (29.8)
Yes	322 (59.2)	24 (58.5)	35 (59.3)	53 (57.0)	19 (52.8)	62 (63.9)	129 (59.2)
Graft status
Died functioning	89 (16.4)	2 (4.9)	9 (15.3)	11 (11.8)	5 (13.9)	7 (7.2)	55 (25.2)
Died unknown function	1 (0.2)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (1.0)	0 (0.0)
Failed	80 (14.7)	5 (12.2)	16 (27.1)	10 (10.8)	4 (11.1)	7 (7.2)	38 (17.4)
Functioning	374 (68.8)	34 (82.9)	34 (57.6)	72 (77.4)	27 (75.0)	82 (84.5)	125 (57.3)
Allocation matchability score	6.8 (2.4)	5.0 (2.4)	4.9 (2.4)	6.0 (2.4)	8.5 (1.7)	7.9 (1.9)	7.3 (2.1)
Serum creatinine (umol/L) 3-month post-transplant	154.8 (61.0)	133.6 (37.9)	219.8 (87.2)	155.1 (53.2)	132.5 (44.0)	114.6 (44.5)	164.8 (53.3)
Serum creatinine (umol/L) 12-month post-transplant	146.6 (57.2)	126.0 (36.3)	199.3 (89.6)	145.5 (56.3)	135.8 (45.1)	111.2 (39.0)	157.9 (49.1)
Follow-up time	5.5 (3.1)	3.3 (1.8)	2.1 (1.7)	6.8 (2.8)	2.4 (1.6)	7.5 (2.4)	5.9 (2.9)
Transplant year
2014	125 (23.0)	0 (0.0)	4 (6.8)	29 (31.2)	1 (2.8)	31 (32.0)	60 (27.5)
2015	80 (14.7)	0 (0.0)	3 (5.1)	19 (20.4)	0 (0.0)	21 (21.6)	37 (17.0)
2016	89 (16.4)	3 (7.3)	8 (13.6)	19 (20.4)	1 (2.8)	12 (12.4)	46 (21.1)
2017	45 (8.3)	0 (0.0)	1 (1.7)	7 (7.5)	2 (5.6)	15 (15.5)	20 (9.2)
2018	49 (9.0)	5 (12.2)	3 (5.1)	10 (10.8)	4 (11.1)	11 (11.3)	16 (7.3)
2019	49 (9.0)	9 (22.0)	6 (10.2)	6 (6.5)	4 (11.1)	5 (5.2)	19 (8.7)
2020	46 (8.5)	7 (17.1)	15 (25.4)	1 (1.1)	9 (25.0)	1 (1.0)	13 (6.0)
2021	44 (8.1)	13 (31.7)	14 (23.7)	1 (1.1)	8 (22.2)	1 (1.0)	7 (3.2)
2022	4 (0.7)	3 (7.3)	0 (0.0)	0 (0.0)	1 (2.8)	0 (0.0)	0 (0.0)
2023	2 (0.4)	1 (2.4)	1 (1.7)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
2024	11 (2.0)	0 (0.0)	4 (6.8)	1 (1.1)	6 (16.7)	0 (0.0)	0 (0.0)
Kidney used by local centre
No	232 (42.6)	28 (68.3)	44 (74.6)	35 (37.6)	25 (69.4)	30 (30.9)	70 (32.1)
Yes	312 (57.4)	13 (31.7)	15 (25.4)	58 (62.4)	11 (30.6)	67 (69.1)	148 (67.9)

BMI: Body mass index; UTI: Urinary tract infection; DBD: Donation after brain death; CMV: Cytomegalovirus; DCD: Donation after cardiac death; HTK: Histidine-tryptophan-ketoglutarate solution; EBV: Epstein-Barr virus; HMP: Hypothermic machine perfusion; NMP: Normothermic machine perfusion; HLA: Human leukocyte antigen; DGF: Delayed graft function; PNF: Primary non-function.

Full Size Table

Table 4 Resulting clusters phenotype summary

Cluster	Core phenotype	Immunologic profile	Outcomes	Allocation/time	MP type	Key modifiers	Transplant centre
1	Young, donor low cardiovascular comorbidity, donor behavioural risk	Low risk (fewer DR/B mismatches)	Intermediate graft survival. Patient survival↑	Low matchability score; recent years	NMP		No local
2	Older, comorbid males	Intermediate risk (DRMM = 1 enriched)	Graft and patient survival↓. Immediate graft function↓	Low matchability score	HMP/NMP	Donor quality↓, ↑(MP subgroup)	No local
3	Immunologically favourable; shorter waiting time, predominantly white recipients	Very low/near-perfect matching (DRMM = 0 dominant)	Graft and patient survival↑	Low matchability score; earlier years	HMP	Shorter CIT (MP subgroup); less dialysis at transplant	Local
4	Immunologically unfavourable, diverse recipient ethnicity, donor risk factors	High risk (DRMM = 2, BMM = 2 enriched)	Graft and patient survival↑ in full cohort	High matchability score; later years	NMP	Longer CIT (MP subgroup); hemodialysis at transplant (MP subgroup)
5	Young, females, donor low cardiovascular comorbidity	Intermediate risk	Graft and patient survival↑	High matchability score; earlier years	HMP	Less dialysis at transplant	Local
6	Older, donor hypertension with no behavioural risk	Intermediate risk	Intermediate graft and patient survival	High matchability score	HMP		Local

B: B locus; BMM: Number of mismatches at B locus; DR: DR locus; DRMM: Number of mismatches at DR locus; HMP: Hypothermic machine perfusion; NMP: Normothermic machine perfusion; CIT: Cold ischemia time.

Full Size Table

Table 5 Clusters’ stability comparison (full cohort vs machine perfusion subgroup)

Cluster	Mean MPP (full cohort)	Median MPP (full cohort)	Mean entropy (full cohort)	Mean MPP (MP subgroup)	Median MPP (MP subgroup)	Mean entropy (MP subgroup)
1	0.678	0.685	0.839	0.607	0.555	1.046
2	0.715	0.723	0.724	0.701	0.699	0.765
3	0.726	0.723	0.664	0.671	0.646	0.759
4	0.756	0.802	0.644	0.723	0.743	0.725
5	0.666	0.658	0.828	0.674	0.689	0.796
6	0.663	0.666	0.903	0.685	0.689	0.831

MPP: Maximum posterior probability; MP: Machine perfusion.

Full Size Table

Table 6 Full cohort features standardized mean differences by cluster

Characteristic	Cluster 1 (n = 2797)	Cluster 2 (n = 2826)	Cluster 3 (n = 2370)	Cluster 4 (n = 1854)	Cluster 5 (n = 2402)	Cluster 6 (n = 3655)
Recipient age	-0.53127	0.890174	-0.37819	0.263441	-0.74394	0.652855
Recipient BMI	-0.05273	0.36501	-0.0351	0.050277	-0.36817	0.051705
Recipient sex
Female	0.046416	-0.37198	-0.0387	0.057848	0.354276	-0.07143
Male	-0.04642	0.371976	0.038704	-0.05785	-0.35428	0.07143
Recipient ABO blood group
A	0.029565	-0.00315	0.072027	-0.09341	-0.03266	0.026294
AB	0.065362	0.025794	-0.06948	-0.01586	0.034174	-0.04917
B	-0.03387	-0.03848	-0.13933	0.186659	0.030704	-0.02611
O	-0.03678	0.017429	0.048903	-0.03802	-0.00484	0.013025
Recipient ethnicity
Asian	-0.06851	-0.13465	-0.33311	0.28277	0.195452	-0.00306
Black	0.016715	-0.00709	-0.24634	0.227795	0.001301	-0.03807
White	0.047113	0.119418	0.451491	-0.41774	-0.17413	0.028319
Recipient diabetes	-0.15378	0.332122	-0.16925	0.148745	-0.3113	0.056299
Recipient positive CMV status	-0.076	-0.037	-0.2564	0.270441	0.030052	0.075713
Dialysis status at registration
Hemodialysis	0.086843	0.213382	-0.28001	0.112707	-0.10092	-0.03491
Not	-0.11826	-0.25069	0.325769	-0.14902	0.111091	0.060756
Peritoneal	0.032607	0.024453	-0.05462	0.035873	-0.00844	-0.03204
Dialysis at transplant	0.097919	0.171868	-0.33548	0.107925	-0.00066	0.004394
Type of dialysis at transplant
Hemodialysis	-0.01072	0.059037	-0.13685	0.044986	0.001169	0.047248
Not	0.108832	-0.00796	-0.0172	-0.02224	-0.09087	-0.01846
Peritoneal	-0.01332	-0.05813	0.140569	-0.04158	0.011823	-0.04447
Donor organ
Left kidney	-0.09442	0.06469	-0.0406	0.080451	-0.14511	0.133529
Right kidney	0.094421	-0.06469	0.0406	-0.08045	0.145105	-0.13353
Highly sensitised status flag	-0.1051	-0.25405	-0.05252	0.278585	0.137113	-0.10495
Waiting list time	0.205676	0.184614	-0.68461	0.155021	0.029542	0.033337
Recipient deprivation group
Quartile 1 most deprived	-0.13673	0.125214	0.135129	-0.11206	-0.14645	0.114791
Quartile 2 second most deprived	-0.0373	0.028104	0.089469	-0.04483	-0.08356	0.043987
Quartile 3 second least deprived	0.086139	-0.01602	-0.12754	0.046672	0.05857	-0.05414
Quartile 4 least deprived	0.078204	-0.14132	-0.10361	0.102159	0.15673	-0.10738
Donor age	-0.77397	1.151346	0.059862	-0.07552	-1.07416	0.922674
Donor BMI	-0.22905	0.335247	0.015342	-0.0657	-0.29796	0.217399
Donor sex
Female	-0.11263	0.072835	0.134812	-0.08067	-0.13794	0.120255
Male	0.112627	-0.07283	-0.13481	0.080672	0.137942	-0.12026
Donor ABO blood group
A	0.039102	0.016699	0.077042	-0.13229	-0.02753	0.024879
AB	0.060752	0.008323	-0.11541	-0.00955	0.054528	-0.01621
B	-0.01511	-0.00672	-0.17588	0.143325	0.030238	0.001161
O	-0.05233	-0.01535	0.059672	0.039371	-0.01204	-0.01951
Donor ethnicity
Asian	0.000514	0.038364	-0.0821	0.024941	0.0001	0.010053
Black	0.00643	-0.01655	-0.01361	0.030552	0.015678	-0.02584
White	-0.00408	-0.02369	0.075358	-0.03827	-0.00908	0.005607
Donor positive CMV status	-0.12041	0.098053	0.021299	-0.06591	-0.06611	0.132632
Donor positive EBV status	0.029951	0.081959	0.001328	0.019402	-0.13784	0.02228
Donor positive toxoplasmosis status	-0.13706	0.095696	0.010196	-0.01706	-0.06299	0.098
Donor cardiac disease	-0.29989	0.452731	-0.07382	-0.09806	-0.3734	0.210295
Donor diabetes	-0.23863	0.303632	-0.02393	-0.02724	-0.25273	0.120616
Donor family history of diabetes	0.117106	-0.06168	-0.04535	0.05733	0.078348	-0.15243
Donor history of drug abuse	0.81861	-0.42472	-0.48799	0.339628	0.105875	-0.68139
Donor hypertension	-0.59749	0.75056	-0.00457	-0.09059	-0.70759	0.419629
Donor smoker	0.386329	-0.04618	-0.28052	0.233903	0.062836	-0.32145
Donor history of UTI	-0.02595	0.051784	-0.0268	-0.00334	-0.05092	0.049397
Donor allergy	0.182199	0.349431	-0.23512	0.17585	-0.37885	-0.12589
Donor creatinine at retrieval	0.111216	-0.20679	-0.04272	0.058724	0.126459	-0.05897
Donor type
DBD	0.163396	-0.21653	0.322543	-0.15502	0.161577	-0.26117
DCD	-0.1634	0.216534	-0.32254	0.155025	-0.16158	0.261166
Donor cause of death
Neurological	0.079257	0.188412	-0.01799	0.032678	-0.25947	0.031494
Other	-0.07926	-0.18841	0.017991	-0.03268	0.259472	-0.03149
Cold ischemia time	0.034621	0.064709	-0.1487	0.110151	-0.03088	-0.03307
Perfusate used
HTK	0.215541	0.290157	-0.37809	0.297393	-0.41002	-0.3985
Marshalls	-0.20981	0.069047	-0.01459	-0.0697	-0.08986	0.273508
Wisconsin	0.024312	-0.25256	0.202352	-0.14489	0.288148	-0.0685
Perfusion quality
Fair	-0.09903	0.066815	-0.02273	0.053659	-0.05518	0.043223
Good	0.124324	-0.07958	0.038627	-0.05322	0.067024	-0.081
Poor	-0.0704	0.039988	-0.03226	0.015022	-0.03558	0.071809
Machine perfusion type
HMP	-0.16465	-0.10792	0.072853	-0.13631	0.066932	0.165752
NMP	-0.02219	-0.00674	-0.03713	0.026516	0.005664	0.028618
SCS	0.139758	0.087785	-0.0411	0.083732	-0.05858	-0.15598
Donor homozygous at A locus	-0.02882	-0.03397	0.331391	-0.14094	-0.08519	-0.08234
Donor homozygous at B locus	0.018333	-0.00219	0.324462	-0.32254	-0.05012	-0.07189
Donor homozygous at DR locus	-0.07049	-0.05484	0.384054	-0.34321	0.018206	-0.03753
Recipient homozygous at A locus	-0.11426	-0.12039	-0.26716	0.185844	0.20061	0.06497
Recipient homozygous at B locus	-0.24938	-0.25056	-0.36106	0.442481	0.216542	0.018343
Recipient homozygous at DR locus	-0.3925	-0.3688	-0.4553	0.514814	0.316519	0.132615
Number of mismatches at A locus
One	0.100524	0.107959	-0.19918	-0.046	-0.00287	0.037924
Two	-0.04103	-0.02375	-0.61386	0.245613	0.214416	0.138909
Zero	-0.08528	-0.11969	0.865188	-0.28684	-0.30846	-0.25372
Number of mismatches at B locus
One	0.194076	0.181726	-0.21583	-1.02907	0.522414	0.361438
Two	-0.43557	-0.20574	-0.80177	1.61737	-0.26989	-0.11265
Zero	0.168862	-0.01822	0.860889	-0.57823	-0.41804	-0.39044
Number of mismatches at DR locus
One	0.156213	0.362725	-1.58327	-0.08453	0.169242	0.572884
Two	-0.49823	-0.29474	-0.53587	1.400915	-0.41166	-0.3312
Zero	0.083765	-0.20624	2.088466	-1.29858	0.038214	-0.39782
HLA mismatch group
(0 DR and 2B) OR (1 DR and 1/0 B)	0.320803	0.492691	-1.5359	-0.88766	0.35718	0.817322
(1 DR and 2 B) OR (2 DR)	-0.64264	-0.32933	-0.73181	2.732471	-0.5118	-0.36669
0 DR and 1/0 B	0.200285	-0.13652	0.942319	-1.01767	0.132115	-0.42344
0 Mismatches	-0.29107	-0.33901	1.013344	-0.3991	-0.3991	-0.3991
Initial graft function
DGF	-0.11953	0.293189	-0.1664	0.075526	-0.21589	0.094297
Immediate	0.107333	-0.35624	0.207118	-0.087	0.260541	-0.08576
PNF	0.019437	0.177065	-0.13987	0.038363	-0.15666	-0.01597
Predniscolone/predniscone immunosuppression 3 months post-transplant
No	-0.10243	-0.02439	0.089443	-0.0981	0.005436	0.123103
Yes	0.102431	0.024386	-0.08944	0.098099	-0.00544	-0.1231
Graft status
Died functioning	-0.25092	0.067352	-0.02856	-0.02329	-0.15542	0.314832
Died unknown function	-0.04474	0.055994	-0.039	0.010615	-0.01671	0.011187
Failed	-0.18583	0.234386	0.023866	-0.09706	-0.13882	0.114523
Functioning	0.330622	-0.24579	0.006453	0.089744	0.222438	-0.33668
Allocation matchability score	-0.82615	-0.91113	-0.48134	0.939133	0.94143	0.608976
Serum creatinine (umol/L) at 3 months post-transplant	-0.55205	1.076702	-0.00929	-0.20292	-1.05008	0.27868
Serum creatinine (umol/L) at 12 months post-transplant	-0.54517	1.001822	0.035808	-0.20997	-0.97139	0.28784
Follow-up time	-1.02083	-1.36537	1.02637	-1.03852	1.304328	0.609898
Transplant year
2014	-0.46973	-0.40766	0.318161	-0.41243	0.36776	0.215761
2015	-0.44461	-0.3679	0.280245	-0.36841	0.317711	0.249368
2016	-0.43155	-0.31821	0.318755	-0.35172	0.25152	0.249478
2017	-0.35466	-0.2451	0.278868	-0.36176	0.238236	0.233183
2018	-0.14226	-0.11021	0.065559	-0.22613	0.162749	0.19049
2019	0.031142	-0.00751	-0.11104	0.1739	-0.14187	0.03025
2020	0.29756	0.11046	-0.33259	0.309795	-0.32021	-0.2833
2021	0.37828	0.319815	-0.4093	0.228833	-0.46416	-0.41834
2022	0.368105	0.342109	-0.43481	0.233157	-0.46783	-0.46145
2023	0.262064	0.285086	-0.3182	0.121005	-0.34658	-0.33995
2024	0.066904	0.161389	-0.30486	0.355243	-0.30492	-0.30949
Kidney used by local centre
No	0.358659	0.266388	-0.07062	0.248008	-0.23235	-0.46553
Yes	-0.35866	-0.26639	0.070616	-0.24801	0.232346	0.465532

BMI: Body mass index; UTI: Urinary tract infection; DBD: Donation after brain death; DCD: Donation after cardiac death; HTK: Histidine-tryptophan-ketoglutarate solution; HMP: Hypothermic machine perfusion; NMP: Normothermic machine perfusion; HLA: Human leukocyte antigen; DGF: Delayed graft function; PNF: Primary non-function.

Full Size Table

Table 7 Machine perfusion subgroup features standardized mean differences by cluster

Characteristic	Cluster 1 (n = 41)	Cluster 2 (n = 59)	Cluster 3 (n = 93)	Cluster 4 (n = 36)	Cluster 5 (n = 97)	Cluster 6 (n = 218)
Recipient age	-0.52238	0.935377	-0.17692	-0.14135	-0.5752	0.624424
Recipient BMI	-0.33675	0.341342	0.100018	0.104799	-0.29737	0.077307
Recipient sex
Female	-0.12192	-0.47267	0.037357	0.329161	0.231682	-0.05627
Male	0.121923	0.472666	-0.03736	-0.32916	-0.23168	0.05627
Recipient ABO blood group
A	0.00696	0.193519	-0.00775	0.011911	-0.07437	-0.13309
AB	0.173135	-0.16482	0.013513	-0.08419	0.062414	-0.0548
B	-0.07912	0.001768	-0.32229	0.169568	-0.01784	0.17967
O	-0.03561	-0.13813	0.183969	-0.09859	0.058822	0.026817
Recipient ethnicity
Asian	-0.07204	-0.10315	-0.33003	0.507309	-0.00709	-0.10166
Black	0.177035	0.076748	-0.40214	0.282133	-0.15149	-0.13602
White	-0.06636	0.031694	0.534651	-0.65321	0.100554	0.173304
Recipient diabetes	-0.11318	0.251095	-0.25194	0.133863	-0.36278	0.217526
Recipient positive CMV status	-0.16999	-0.02122	-0.31585	0.471722	0.070829	-0.01996
Dialysis status at registration
Hemodialysis	-0.04066	0.256224	-0.24872	0.630677	-0.46044	-0.11067
Not	-0.16484	-0.04565	0.272456	-0.43957	0.263876	0.070191
Peritoneal	0.261768	-0.34949	-0.02704	-0.32742	0.252628	0.060744
Dialysis at transplant	0.060974	0.136638	-0.17833	0.330709	-0.08688	-0.18986
Type of dialysis at transplant
Hemodialysis	-0.26222	0.116985	-0.06999	0.45709	-0.08642	-0.08056
Not	0.235702	-0.10426	-0.10426	-0.10426	-0.10426	-0.10426
Peritoneal	0.203308	-0.1042	0.083027	-0.4446	0.099488	0.093619
Donor organ
Left kidney	-0.03682	0.012793	0.082894	-0.20909	-0.11916	0.271376
Right kidney	0.036822	-0.01279	-0.08289	0.209092	0.119164	-0.27138
Highly sensitised status flag	-0.04705	-0.24711	-0.07932	0.239504	0.207115	-0.20468
Waiting list time	0.293259	0.292544	-0.51323	0.140545	-0.11534	-0.19133
Recipient deprivation group
Quartile 1 most deprived	0.144294	0.009881	0.047681	-0.19907	-0.02608	0.012131
Quartile 2 second most deprived	-0.29413	0.468065	-0.08528	-0.02003	-0.2488	0.103914
Quartile 3 second least deprived	-0.06986	-0.25307	-0.02343	0.291574	0.042275	-0.0128
Quartile 4 least deprived	0.171772	-0.25815	0.053363	-0.09517	0.199419	-0.10384
Donor age	-0.68036	0.878226	0.228306	-0.07469	-1.10569	0.959388
Donor BMI	-0.43307	0.415931	0.055243	-0.05396	-0.33119	0.259145
Donor sex
Female	-0.29708	0.014101	0.296941	0.079911	-0.35442	0.227365
Male	0.297078	-0.0141	-0.29694	-0.07991	0.354417	-0.22736
Donor ABO blood group
A	0.045051	0.172103	-0.00267	-0.07713	-0.01967	-0.11994
AB	0.151565	-0.07105	-0.03261	0.015795	-0.03985	-0.05891
B	-0.03287	0.048817	-0.33718	0.218087	-0.09518	0.118041
O	-0.08087	-0.18356	0.190299	-0.07592	0.087987	0.05895
Donor ethnicity
Asian	-0.09388	0.172408	-0.09388	-0.09388	-0.09388	0.019577
Black	0.235702	-0.10426	-0.10426	-0.10426	-0.10426	-0.10426
White	-0.18284	-0.10107	0.140638	0.140638	0.140638	0.050717
Donor positive CMV status	-0.15319	-0.07133	-0.12388	0.179753	0.047903	0.118171
Donor positive EBV status	-0.09206	0.003988	-0.01369	0.12261	0.002437	-0.0115
Donor positive toxoplasmosis status	0.085221	-0.05017	0.100121	-0.19446	-0.10309	0.136286
Donor cardiac disease	-0.02698	0.549406	-0.207	-0.07812	-0.37416	-0.01591
Donor diabetes	-0.37831	0.475118	-0.20372	0.007774	-0.13606	-0.02641
Donor family history of diabetes	-0.06424	0.279421	-0.16018	-0.023	-0.03486	-0.0104
Donor history of drug abuse	0.834764	-0.49937	-0.67434	0.437373	0.154552	-0.65409
Donor hypertension	-0.67428	1.019971	-0.23869	-0.06014	-0.66262	0.343796
Donor smoker	0.18875	0.098478	-0.23545	0.284012	0.191422	-0.50291
Donor history of UTI	-0.01377	0.183746	-0.15672	0.14669	-0.2279	-0.00165
Donor allergy	0.153133	0.428873	-0.21322	0.413296	-0.60394	-0.24876
Donor creatinine at retrieval	0.125502	-0.42356	-0.02563	-0.096	0.351898	0.014002
Donor type
DBD	0.007415	-0.10228	-0.03346	0.273614	-0.09862	-0.10432
DCD	-0.00741	0.102277	0.033465	-0.27361	0.098615	0.10432
Donor cause of death
Neurological	0.26055	0.454746	-0.35274	0.090477	-0.15611	-0.07575
Other	-0.26055	-0.45475	0.352744	-0.09048	0.156112	0.075749
Cold ischemia time	-0.04488	0.342452	-0.45242	0.597162	-0.26049	-0.19252
Perfusate used
HTK	-0.03971	0.03199	-0.06026	0.294468	-0.16003	-0.21855
Marshalls	-0.34773	0.217686	0.179445	-0.42416	-0.04817	0.282263
Wisconsin	0.338959	-0.21966	-0.14738	0.191593	0.106176	-0.19929
Perfusion quality
Fair	-0.39856	0.091242	0.122445	-0.11029	0.215936	-0.02153
Good	0.225004	-0.18566	-0.09372	0.166457	-0.10417	0.027697
Poor	0.074921	0.158416	-0.00977	-0.11489	-0.12394	-0.01525
Machine perfusion type
HMP	-0.62818	-0.18049	0.573901	-0.58306	0.42157	0.439779
NMP	0.62818	0.180493	-0.5739	0.583062	-0.42157	-0.43978
Donor homozygous at A locus	0.021713	0.146149	0.112907	-0.25555	-0.0396	-0.01395
Donor homozygous at B locus	0.02525	-0.02818	0.14671	-0.49644	0.237927	-0.03754
Donor homozygous at DR locus	-0.10806	-0.12001	0.626996	-0.51105	0.071818	-0.15142
Recipient homozygous at A locus	0.044589	-0.14692	-0.41768	0.125595	0.168964	0.146465
Recipient homozygous at B locus	-0.3114	-0.08202	-0.28739	0.408741	0.074077	0.066697
Recipient homozygous at DR locus	-0.54784	-0.41639	-0.35489	0.589812	0.238174	0.188202
Number of mismatches at A locus
One	0.097199	-0.10749	0.212251	-0.03473	-0.08176	-0.08028
Two	-0.29478	0.128613	-0.58751	0.229485	0.228751	0.173743
Zero	0.19625	-0.01389	0.309202	-0.26653	-0.18904	-0.1127
Number of mismatches at B locus
One	0.048535	-0.00741	0.204379	-0.86645	0.476811	0.170374
Two	-0.48232	0.012601	-0.83654	1.326824	-0.2564	-0.04173
Zero	0.40401	-0.00523	0.446308	-0.5802	-0.39206	-0.2065
Number of mismatches at DR locus
One	0.483892	0.361597	-1.98063	0.104253	0.122609	0.334855
Two	-0.4994	-0.18924	-0.4994	0.968966	-0.23929	-0.08191
Zero	-0.25134	-0.26978	2.62874	-1.17182	0.002459	-0.30515
HLA mismatch group
(0 DR and 2B) OR (1 DR and 1/0 B)	0.673474	0.521873	-1.75727	-0.62392	0.28404	0.447561
(1 DR and 2 B) OR (2 DR)	-0.63189	-0.11729	-0.7675	1.718072	-0.36943	-0.1061
0 DR and 1/0 B	-0.18083	-0.42722	1.80884	-0.94859	0.05366	-0.34678
0 Mismatches	-0.26696	-0.26696	0.644658	-0.26696	-0.26696	-0.26696
Initial graft function
DGF	-0.29227	0.364925	-0.0898	0.109398	-0.13641	-0.00691
Immediate	0.191538	-0.4476	0.15867	-0.0392	0.205079	-0.02326
PNF	0.181014	0.220671	-0.24713	-0.24713	-0.24713	0.07753
Predniscolone/predniscone immunosuppression 3 months post-transplant
No	-0.08321	-0.32889	0.146769	0.159979	-0.00221	0.079611
Yes	0.083214	0.328894	-0.14677	-0.15998	0.002211	-0.07961
Graft status
Died functioning	-0.33468	0.076472	-0.04423	0.029598	-0.22774	0.38821
Died unknown function	-0.06428	-0.06428	-0.06428	-0.06428	0.144338	-0.06428
Failed	-0.07421	0.396202	-0.12747	-0.11402	-0.26933	0.103673
Functioning	0.299809	-0.38451	0.136365	0.068689	0.35079	-0.39189
Allocation matchability score	-0.89236	-0.89449	-0.31801	1.168311	0.775282	0.397993
Serum creatinine (umol/L) at 3 months post-transplant	-0.49329	1.139701	0.037743	-0.50205	-0.92856	0.25578
Serum creatinine (umol/L) at 12 months post-transplant	-0.5095	0.901736	-0.009	-0.24362	-0.87226	0.279751
Follow-up time	-0.81744	-1.51375	1.030244	-1.33825	1.48027	0.590485
Transplant year
2014	-0.70809	-0.36308	0.425425	-0.55108	0.447064	0.3227
2015	-0.54249	-0.24363	0.335796	-0.54249	0.373961	0.224117
2016	-0.21921	0.022467	0.247963	-0.43858	-0.02	0.268664
2017	-0.41371	-0.2814	0.045193	-0.0506	0.359465	0.11809
2018	0.099585	-0.20458	0.044465	0.058397	0.067217	-0.09786
2019	0.387393	-0.0166	-0.17485	0.02006	-0.23666	-0.07566
2020	0.153595	0.41158	-0.52733	0.399002	-0.53008	-0.26831
2021	0.546193	0.314455	-0.56336	0.269375	-0.56604	-0.4434
2022	0.353089	-0.20301	-0.20301	0.091326	-0.20301	-0.20301
2023	0.180164	0.11638	-0.12913	-0.12913	-0.12913	-0.12913
2024	-0.32116	0.146404	-0.21728	0.54339	-0.32116	-0.32116
Kidney used by local centre
No	0.400771	0.574001	-0.35512	0.431431	-0.53165	-0.49953
Yes	-0.40077	-0.574	0.355118	-0.43143	0.531653	0.499525

BMI: Body mass index; UTI: Urinary tract infection; DBD: Donation after brain death; CMV: Cytomegalovirus; EBV: Epstein-Barr virus; DCD: Donation after cardiac death; HTK: Histidine-tryptophan-ketoglutarate solution; HMP: Hypothermic machine perfusion; NMP: Normothermic machine perfusion; HLA: Human leukocyte antigen; DGF: Delayed graft function; PNF: Primary non-function.

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Table 8 Cross-Dataset cluster alignment metrics

Full cohort cluster	MP subgroup cluster	Pearson r	Mean absolute SMD difference
1	1	0.843	0.130
2	2	0.895	0.128
3	3	0.902	0.152
4	4	0.865	0.164
5	5	0.895	0.117
6	6	0.867	0.101

SMD: Standardized mean difference; MP: Machine perfusion.

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Citation: Castellanos De Brigard J, Rangganata E, Papalois VE. Machine perfusion distribution across clinical phenotypes in kidney transplantation: A national cohort study using unsupervised clustering. World J Transplant 2026; 16(3): 121821
URL: https://www.wjgnet.com/2220-3230/full/v16/i3/121821.htm
DOI: https://dx.doi.org/10.5500/wjt.121821

Castellanos De Brigard J, Rangganata E, Papalois VE. Machine perfusion distribution across clinical phenotypes in kidney transplantation: A national cohort study using unsupervised clustering. World J Transplant 2026; 16(3): 121821 [DOI: 10.5500/wjt.121821]

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