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Figure S1, SDC

Figure S1, SDC: A sample of 66,596 first adult kidney transplants with organs from living donors were performed between 1987 and 2013 with a projected median survival of 24.4 years. These are compared with 189,141 transplants during the same period with kidneys from deceased donors with a projected median survival of 18.0 years.10 Median survival was calculated from unadjusted data that span the 25 years duration, 1987-2013. Therefore their projected median values are not expected to match K-M curves that are calculated only from a shorter, more recent period in which the survival of allografts in both strata has improved.

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Figure S2, SDC

Figure S2, SDC: The mean of the 32 z values was -0.02 and was not significantly different from 0.0 by t-test (p = 0.95); the standard deviation is 1.50, 95% empirical confidence interval is estimated with the bootstrap (b=1000), (1.05, 1.86); the tests for normality—Shapiro-Wilk (p = 0.52), Kolmogorov-Smirnov (p > 0.15), Cramer-von Mises (p > 0.25), and Anderson-Darling (p > 0.25)—do not reject the null hypothesis of a normal distribution. Therefore, the Cox fully adjusted regression for all living donors for first adult kidney transplants 1987-2013 is well specified.

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Figure S3, SDC

Figure S3, SDC: The mean of the 124 z values was -0.07 and was not significantly different from 0.0 by t-test (p = 0.54); the standard deviation is 1.23 with 95% empirical confidence interval estimated with the bootstrap (b=1000), (1.08, 1.38); the tests for normality—Shapiro-Wilk (p = 0.89), Kolmogorov-Smirnov (p > 0.15), Cramer-von Mises (p > 0.25), and Anderson-Darling (p > 0.25)—do not reject the null hypothesis of a normal distribution. Therefore, the Cox fully adjusted regression for all first adult kidney transplants, 1987-2013, is well specified.

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Figure S4, SDC

Figure S4, SDC: A Cox multivariate regression was performed with the survival time of kidney allografts from living donors as the dependent variable and an HLA mismatch categorical variable with categories as the primary explanatory variable with category living-related 0-mismatch as the reference. HR values for the full model are presented in Table 3. The blue line is fitted to the full model observed values with intercept 1.26 (1.04, 1.48), p < 0.0001, and slope of 0.14 (0.08, 0.20), p = 0.0004.

Table S1, SDC

Ordinary Least Square Regression of Schoenfeld Residuals of Individual Cox Model Variables

on Survival Time of First Adult Kidneys from Living Donors to Test the Proportional Hazards

Assumptiona

All Living Donors (N=66,596)

7,726 Events

Variable Beta R-Square P

Recipient Age 0.0000 0.0014 0.0011

Donor Age 0.0000 0.0000 0.8272

Recipient Gender -0.0000 0.0000 0.6321

Donor Gender -0.0000 0.0000 0.8971

Five Year Intervals -0.0000 0.0000 0.5774

Ethnicity -0.0000 0.0001 0.4185

Peak PRA -0.0000 0.0021 <.0001

Education -0.0000 0.0012 0.0025

Recipient BMI 0.0000 0.0009 0.0054

Working at Tx 0.0000 0.0002 0.1764

Dialysis Duration 0.0000 0.0001 0.2956

Dialysis Type 0.0000 0.0008 0.0149

Induction 0.0000 0.0003 0.1377

Immunosuppression 0.0000 0.0006 0.0348

HLA Mismatch 0.0000 0.0001 0.4396

a. The beta coefficient was never larger than 0.0001 and R-square did not exceed

0.0021. The large size of the sample for each regression created very small standard

errors. Therefore beta was significantly greater than 0.0 for a number of variables but

the low R-square demonstrated a lack of correlation between the 2 variables in each

instance.

Table S2, SDC

Z Table for the Goodness of Fit Test for the Cox Proportional Hazards Fully

Adjusted Model for all Allografts from Living Donors with 33 Categoriesa

Group Observed

Events

Expected

Events

z

1 19 25.996 -1.37206

2 42 36.432 0.92245

3 65 46.868 3.21696

4 88 57.304 5.51147

5 111 67.74 7.80598

6 134 78.176 10.10049

7 157 88.612 12.395

8 180 99.048 14.68951

9 203 109.484 16.98402

10 226 119.92 19.27853

11 249 130.356 21.57304

12 272 140.792 23.86755

13 295 151.228 26.16206

14 318 161.664 28.45657

15 341 172.1 30.75108

16 364 182.536 33.04559

17 387 192.972 35.3401

18 410 203.408 37.63461

19 433 213.844 39.92912

20 456 224.28 42.22363

21 479 234.716 44.51814

22 502 245.152 46.81265

23 525 255.588 49.10716

24 548 266.024 51.40167

25 571 276.46 53.69618

26 594 286.896 55.99069

27 617 297.332 58.2852

28 640 307.768 60.57971

29 663 318.204 62.87422

30 686 328.64 65.16873

31 709 339.076 67.46324

32 732 349.512 69.75775

a: adjustment for recipient age, donor age, recipient sex, donor sex, transplant era,

recipient ethnicity, recipient peak PRA, recipient education, recipient BMI, recipient

dialysis type, recipient working for income at transplant, years on dialysis greater than

or equal to the median, induction, immunosuppression at discharge, and HLA

mismatch.

Table S3, SDC

Ordinary Least Square Regression of Schoenfeld Residuals of Individual Cox Model

Variables on Survival Time of First Adult Kidneys to Test the Proportional Hazards

Assumptiona

All Donors (N=255,737)

49,713 Events

Variable Beta R-Square p

Recipient Age 0.0000 0.0004 <.0001

Donor Age 0.0000 0.0000 >0.05

Donor Gender 0.0000 0.0006 <.0001

Five Year Intervals 0.0000 0.0008 <.0001

Ethnicity 0.0000 0.0002 0.0012

Cold Ischemia Time -0.0000 0.0001 >0.05

Peak PRA -0.0000 0.0004 <.0001

Education 0.0000 0.0016 <.0001

Recipient BMI 0.0000 0.0001 0.0334

Donor BMI 0.0000 0.0000 >0.05

Diabetes Pre-transplant 0.0000 0.0001 0.0102

Working at Tx 0.0000 0.0003 <.0001

Drug Treatment COPD 0.0000 0.0001 0.0205

Dialysis Type 0.0000 0.0007 <.0001

Donor Type 0.0000 0.0000 >0.05

Waiting Time 0.0000 0.0000 >0.05

Induction -0.0000 0.0000 <.0001

Immunosuppression -0.0000 0.0013 <.0001

HLA Mismatch 0.0000 0.0000 >0.05

a. The beta coefficient was never larger than 0.0001 and R-square did not exceed

0.0018. The large size of the sample for each regression, 41987, created very small

standard errors. Therefore beta was significantly greater than 0.0 for a number of

variables but the low R-square demonstrated a lack of correlation between the 2

variables in each instance.

Table S4, SDC

Z Table for the Goodness of Fit Test for the Cox Proportional Hazards Fully Adjusted

Model for the 0-Mismatch Categorical Variable across all Strata of Donor Source

(N=255,737) with 125 Categoriesa

Group Observed Events Expected Events z

1 19 29.39 -1.917

2 33 38.52 -0.89004

3 34 43.72 -1.47059

4 44 49.89 -0.83386

5 53 54 -0.13607

6 54 57.64 -0.47914

7 42 61.84 -2.52309

8 54 66.97 -1.58543

9 56 67.72 -1.42475

10 72 71.84 0.01887

11 66 74.02 -0.93235

12 63 80.93 -1.99263

13 57 86.02 -3.12889

14 85 88.42 -0.36325

15 80 91.95 -1.24573

16 83 98.07 -1.52168

17 77 97.52 -2.07776

18 91 102.56 -1.14137

19 120 105.87 1.37299

20 104 108.13 -0.39698

21 88 114.41 -2.46937

22 98 117.24 -1.77657

23 99 122.3 -2.10706

24 139 124.9 1.26157

25 130 126.62 0.30006

26 120 132.26 -1.06635

27 115 134.98 -1.71974

28 151 139.13 1.00671

29 159 145.7 1.1016

30 157 144.6 1.03109

31 140 154.96 -1.20212

32 146 156.54 -0.84244

33 159 158.07 0.07384

34 160 164.26 -0.33255

35 183 170.66 0.94496

36 176 169.35 0.51062

37 171 174.85 -0.29099

38 161 175.33 -1.08219

39 203 189.58 0.97457

40 180 189.66 -0.70124

41 176 195.88 -1.42035

42 194 194.41 -0.02951

43 233 195.99 2.6438

44 212 211.46 0.03703

45 211 212.84 -0.12636

46 219 221.09 -0.14087

47 213 223.98 -0.73364

48 225 229.93 -0.32501

49 233 231.91 0.07157

50 236 238.59 -0.16784

51 243 250.97 -0.50333

52 252 244.63 0.4713

53 248 256.77 -0.54748

54 254 266.13 -0.74363

55 262 271.36 -0.56848

56 261 269.78 -0.53443

57 292 274.83 1.03553

58 292 287.42 0.27042

59 279 294.35 -0.8948

60 281 298.69 -1.02378

61 296 295.04 0.0559

62 366 302.28 3.66492

63 338 316.4 1.21439

64 311 323.46 -0.69281

65 330 332.53 -0.13883

66 354 334.36 1.07382

67 346 335.58 0.56859

68 340 357.07 -0.90343

69 361 345.31 0.84455

70 363 363.45 -0.02356

71 375 365.12 0.51715

72 348 378.13 -1.54935

73 386 390.1 -0.20738

74 353 392.71 -2.00384

75 406 381.94 1.23093

76 420 403.75 0.80889

77 445 403.96 2.04195

78 452 414.56 1.83891

79 431 417.14 0.67881

80 445 429.9 0.72815

81 484 438.78 2.15886

82 448 462.51 -0.67487

83 468 473.19 -0.23838

84 468 461.71 0.29252

85 443 490.47 -2.14351

86 518 496.96 0.94368

87 516 500.34 0.70025

88 499 521.15 -0.97047

89 520 523.57 -0.15605

90 509 516.46 -0.32814

91 561 534.88 1.1293

92 560 545.8 0.60775

93 580 553.09 1.14439

94 588 566.93 0.8848

95 602 565.17 1.54924

96 608 581 1.12006

97 629 595.39 1.37743

98 638 607.35 1.24355

99 647 643.62 0.1333

100 650 668.92 -0.73148

101 671 665.49 0.21374

102 694 676.62 0.66832

103 739 679.67 2.27576

104 761 695.61 2.47923

105 713 732.41 -0.71711

106 748 702.53 1.71542

107 776 727.63 1.7931

108 757 749.41 0.27721

109 770 734.44 1.31208

110 772 780.08 -0.28923

111 803 790.67 0.43851

112 829 799.32 1.04989

113 817 809.71 0.25614

114 859 844.35 0.50422

115 848 855.03 -0.24046

116 930 886.72 1.45326

117 903 912.66 -0.31986

118 977 948.19 0.93565

119 976 1038.54 -1.94077

120 1011 1070.36 -1.8143

121 995 1060.07 -1.99846

122 1087 1112.58 -0.76696

123 1182 1168.19 0.40395

124 1194 1251.31 -1.62026

a. adjustment for recipient age, donor age, donor sex, transplant era, recipient ethnicity,

recipient diabetes, cold ischemia time, recipient peak PRA, recipient education,

recipient BMI, donor BMI, recipient working for income at transplant, recipient COPD,

recipient dialysis type, donor source, waiting time for transplant, induction and

immunosuppression at discharge, HLA mismatch.

Table S5, SDC

Hazard ratio for risk of allograft failure by HLA mismatch with 0-Mismatch as the reference among adult (age ≥18 years),

first kidney only transplant recipients receiving organs from living donors. Reduced model with adjustment for recipient

age, recipient sex, and transplant era.

All Living Donors Living-Related Donors Living-Unrelated Donors

HLA

Mismatch N H.R. 95% C.I. p N H.R. 95% C.I. p N H.R. 95% C.I. p

0 5916 1.00 Reference 5770 1.00 Reference 146 1.00 Reference

1 3557 1.45 1.27,1.65 <.0001 3327 1.44 1.26, 1.64 <.0001 230 1.64 0.79, 3.42 >0.05

2 11036 1.70 1.54,1.88 <.0001 9857 1.71 1.54, 1.89 <.0001 1179 1.69 0.93, 3.08 >0.05

3 18424 1.94 1.77, 2.13 <.0001 14681 1.94 1.76, 2.14 <.0001 3743 2.12 1.18, 3.78 0.0114

4 9856 1.78 1.60,1.98 <.0001 2753 1.92 1.69, 2.19 <.0001 7103 1.94 1.09, 3.46 0.0242

5 11515 1.93 1.74, 2.14 <.0001 2773 2.06 1.81, 2.35 <.0001 8742 2.14 1.21, 3.81 0.0094

6 6292 2.17 1.94, 2.43 <.0001 1435 2.17 1.85, 2.55 <.0001 4857 2.49 1.39, 4.43 0.0021

a: adjustment for recipient age, sex, and transplant era.

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Table S6, SDC

Hazard ratio for risk of allograft Failure for HLA mismatch triple with [0,0,0] as the

reference among adult (age ≥18 years), first kidney only transplant recipients receiving

organs from a living donora

All Living Donors

Mismatch

Category

Triple

[A,B,DR]

Number H.R. 95% C.I. p

0 [0,0,0] 5916 1.00 Reference

1 [0,0,1] 1149 1.49 1.24, 1.79 <.0001

1 [0,1,0] 1377 1.41 1.18, 1.69 0.0002

1 [1,0,0] 1031 1.43 1.16, 1.75 0.0006

2 [0,0,2] 75 1.37 0.77, 2.43 >0.05

2 [0,1,1] 4752 1.69 1.51, 1.91 <.0001

2 [0,2,0] 99 1.81 1.02, 3.21 0.0419

2 [1,0,1] 1938 1.77 1.53, 2.06 <.0001

2 [1,1,0] 4123 1.58 1.40, 1.79 <.0001

2 [2,0,0] 49 0.73 0.23, 2.26 >0.05

3 [0,1,2] 450 1.92 1.45, 2.56 <.0001

3 [0,2,1] 724 1.86 1.46, 2.36 <.0001

3 [1,0,2] 167 2.33 1.57, 3.45 <.0001

3 [1,1,1] 16028 1.90 1.73, 2.09 <.0001

3 [1,2,0] 535 1.23 0.89, 1.69 >0.05

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3 [2,0,1] 171 1.22 0.69, 2.16 >0.05

3 [2,1,0] 349 1.66 1.18, 2.32 0.0035

4 [0,2,2] 854 1.42 1.10, 1.82 0.0065

4 [1,1,2] 2302 1.81 1.56, 2.10 <.0001

4 [1,2,1] 4021 1.72 1.51, 1.96 <.0001

4 [2,0,2] 109 2.22 1.33, 3.71 0.0024

4 [2,1,1] 2016 1.93 1.66, 2.26 <.0001

4 [2,2,0] 554 1.84 1.40, 2.40 <.0001

5 [1,2,2] 5182 2.04 1.81, 2.30 <.0001

5 [2,1,2] 1908 1.80 1.53, 2.12 <.0001

5 [2,2,1] 4425 1.79 1.57, 2.03 <.0001

6 [2,2,2] 6292 2.12 1.89, 2.37 <.0001

a: adjustment for recipient age, donor age, recipient sex, donor sex, transplant era,

recipient ethnicity, recipient peak PRA, recipient education, recipient BMI, recipient

dialysis type, recipient working for income at transplant, years on dialysis greater than

or equal to the median, induction and immunosuppression at discharge.

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Table S7, SDC

Tests of Equality (1 d.f.) for the Triples of HLA Mismatch for all First Adult Kidney

Transplants from Living Donors in a Full Model Cox Multivariate Regression and with a

Holm-Bonferroni Correction for Multiple Testsa

Test Mismatch

Category Test

Chi

squaredp Adjusted p

1 3 [111]:[120] 7.59 0.0059 0.0009

2 3 [102]:[120] 6.46 0.0110 0.0009

3 3 [022]:[211] 5.12 0.0236 0.0009

4 3 [012]:[120] 4.58 0.0323 0.0009

5 3 [021]:[120] 4.55 0.0330 0.0009

6 3 [122]:[221] 4.48 0.0342 0.0010

7 3 [102]:[201] 3.44 0.0636 0.0010

8 3 [022]:[112] 3.24 0.0718 0.0010

9 3 [022]:[202] 2.45 0.1178 0.0010

10 3 [122]:[212] 2.36 0.1245 0.0010

11 5 [101]:[200] 2.35 0.1249 0.0011

12 2 [111]:[201] 2.35 0.1249 0.0011

13 3 [022]:[121] 2.18 0.1394 0.0011

14 3 [101]:[110] 2.18 0.1395 0.0011

15 3 [011]:[200] 2.1 0.1438 0.0012

16 5 [022]:[220] 2.10 0.1469 0.0012

P a g e  | 18 

 

17 4 [012]:[201] 2.04 0.1534 0.0012

18 3 [020]:[200] 2.00 0.1572 0.0013

19 4 [121]:[211] 2.00 0.1577 0.0013

20 2 [021]:[201] 1.85 0.1735 0.0013

21 1 [110]:[200] 1.80 0.1794 0.0014

22 4 [102]:[210] 1.74 0.1870 0.0014

23 2 [120]:[210] 1.70 0.1926 0.0014

24 4 [011]:[110] 1.26 0.2615 0.0015

25 3 [102]:[111] 1.06 0.3034 0.0015

26 3 [021]:[102] 0.98 0.3211 0.0016

27 2 [002]:[200] 0.96 0.3282 0.0016

28 4 [121]:[202] 0.92 0.3370 0.0017

29 1 [201]:[210] 0.85 0.3559 0.0017

30 1 [002]:[101] 0.76 0.3832 0.0018

31 4 [111]:[210] 0.66 0.4165 0.0019

32 2 [012]:[102] 0.63 0.4288 0.0019

33 3 [112]:[202] 0.58 0.4450 0.0020

34 2 [112]:[211] 0.56 0.4554 0.0021

35 2 [002]:[011] 0.53 0.4653 0.0022

36 4 [012]:[210] 0.48 0.4904 0.0023

37 3 [002]:[020] 0.47 0.4923 0.0024

38 4 [202]:[220] 0.43 0.5145 0.0025

39 3 [112]:[121] 0.40 0.5294 0.0026

P a g e  | 19 

 

40 4 [011]:[101] 0.36 0.5466 0.0028

41 4 [021]:[210] 0.32 0.5704 0.0029

42 4 [202]:[211] 0.26 0.6095 0.0031

43 4 [002]:[110] 0.25 0.6204 0.0033

44 2 [020]:[110] 0.22 0.6425 0.0036

45 2 [121]:[220] 0.21 0.6462 0.0038

46 3 [001]:[010] 0.20 0.6532 0.0042

47 2 [010]:[100] 0.20 0.6532 0.0045

48 2 [211]:[220] 0.13 0.7182 0.0050

49 2 [001]:[100] 0.12 0.7307 0.0056

50 4 [011]:[020] 0.05 0.8180 0.0063

51 3 [012]:[021] 0.04 0.8455 0.0071

52 4 [021]:[111] 0.03 0.8500 0.0083

53 2 [112]:[220] 0.01 0.9216 0.0100

54 2 [012]:[111] 0.01 0.9260 0.0125

55 2 [020]:[101] 0.01 0.9398 0.0167

56 4 [212]:[221] 0.01 0.9401 0.0250

57 5 [120]:[201] 0.00 0.9754 0.0500

a. adjustment for recipient age, donor age, recipient sex, donor sex, transplant era,

recipient ethnicity, recipient peak PRA, recipient education, recipient BMI, recipient

dialysis type, recipient working for income at transplant, years on dialysis greater than

or equal to the median, induction and immunosuppression at discharge.

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Table S8, SDC

Tests of Equality (1 d.f.) for the Triples of HLA Mismatch for all (N=255,737) First Adult

Kidney Transplants in a Full Model Cox Multivariate Regression and with a Holm-

Bonferroni Correction for Multiple Testsa

Test Mismatch

Category Test

Chi

squaredp Adjusted p

1 3 [012]:[210] 15.0527 0.0001 0.0009

2 3 [111]:[210] 11.2004 0.0008 0.0009

3 3 [012]:[120] 10.2267 0.0014 0.0009

4 3 [102]:[210] 9.5637 0.002 0.0009

5 3 [021]:[210] 7.741 0.0054 0.0009

6 3 [102]:[120] 6.3716 0.0116 0.0010

7 3 [012]:[111] 4.8542 0.0276 0.0010

8 3 [111]:[120] 4.551 0.0329 0.0010

9 3 [012]:[201] 4.2702 0.0388 0.0010

10 3 [021]:[120] 4.0442 0.0443 0.0010

11 5 [122]:[221] 3.8755 0.049 0.0011

12 2 [011]:[110] 3.3793 0.066 0.0011

13 3 [201]:[210] 2.6853 0.1013 0.0011

14 3 [102]:[201] 2.5947 0.1072 0.0011

15 3 [102]:[111] 2.4378 0.1184 0.0012

16 5 [122]:[212] 2.2773 0.1313 0.0012

P a g e  | 21 

 

17 4 [112]:[211] 2.2185 0.1364 0.0012

18 3 [012]:[021] 1.8771 0.1707 0.0013

19 4 [202]:[211] 1.736 0.1876 0.0013

20 2 [020]:[110] 1.6432 0.1999 0.0013

21 1 [001]:[100] 1.5243 0.217 0.0014

22 4 [202]:[220] 1.4516 0.2283 0.0014

23 4 [112]:[220] 1.1804 0.2773 0.0014

24 2 [011]:[101] 1.1639 0.2807 0.0015

25 4 [121]:[202] 0.9687 0.325 0.0015

26 2 [020]:[101] 0.9585 0.3276 0.0016

27 3 [021]:[102] 0.9373 0.333 0.0016

28 3 [120]:[201] 0.9114 0.3398 0.0017

29 4 [121]:[211] 0.8984 0.3432 0.0017

30 1 [001]:[010] 0.8557 0.355 0.0018

31 1 [010]:[100] 0.8557 0.355 0.0019

32 2 [002]:[020] 0.7639 0.3821 0.0019

33 3 [021]:[201] 0.7257 0.3943 0.0020

34 3 [120]:[210] 0.6219 0.4303 0.0021

35 4 [022]:[202] 0.5982 0.4393 0.0022

36 2 [110]:[200] 0.5822 0.4454 0.0023

37 2 [002]:[011] 0.5618 0.4535 0.0024

38 4 [112]:[121] 0.5068 0.4765 0.0025

39 4 [112]:[202] 0.4413 0.5065 0.0026

P a g e  | 22 

 

40 3 [021]:[111] 0.4078 0.5231 0.0028

41 4 [022]:[211] 0.3759 0.5398 0.0029

42 4 [121]:[220] 0.3501 0.5541 0.0031

43 3 [111]:[201] 0.2592 0.6107 0.0033

44 2 [101]:[110] 0.2401 0.6242 0.0036

45 4 [022]:[220] 0.2393 0.6247 0.0038

46 2 [101]:[200] 0.2121 0.6451 0.0042

47 2 [002]:[200] 0.1968 0.6573 0.0045

48 2 [020]:[200] 0.1955 0.6584 0.0050

49 2 [011]:[020] 0.1752 0.6755 0.0056

50 4 [022]:[112] 0.0876 0.7673 0.0063

51 3 [012]:[102] 0.0486 0.8255 0.0071

52 2 [002]:[110] 0.0356 0.8504 0.0083

53 2 [011]:[200] 0.0242 0.8763 0.0100

54 4 [022]:[121] 0.0161 0.899 0.0125

55 4 [211]:[220] 0.0097 0.9215 0.0167

56 2 [002]:[101] 0.009 0.9244 0.0250

57 5 [212]:[221] 0.0004 0.9849 0.0500

a. adjustment for recipient age, donor age, donor sex, transplant era, recipient ethnicity,

recipient diabetes, cold ischemia time, recipient peak PRA, recipient education,

recipient BMI, donor BMI, recipient working for income at transplant, recipient COPD,

recipient dialysis type, kidney source for all persons, waiting time for transplant,

induction and immunosuppression at discharge.