Live-donor kidney transplantation has significantly increased the size of the donor pool, and live-unrelated kidney transplantation, especially spousal donation has increased exponentially. Living unrelated and related kidney transplantation has been shown to have similar allograft survival. However, the effect of donor-recipient relationship in living-related and unrelated kidney transplantation on graft and patient survival remains uncertain. Thus, the aim of this study was to evaluate the effect of live-donor types and graft outcomes.
From January 2009 to January 2018, a total of 2,680 kidney transplants were performed at Asan Medical Center, while 2,060 living donor kidney transplantations were performed. We studied 864 female recipients from living donors with pregnancy history, and HLA-incompatible, re-transplantation and those without or unknown pregnancy history were excluded. The female recipients were categorized into three groups; Offspring-to-mother (Group I), husband-to-wife (Group II), and other unrelated donors (Group III).
The primary endpoint of this study was biopsy-proven acute rejection and graft survival. We also evaluated delayed graft function (DGF), death-censored graft failure and mortality.
Number of HLA ABDR mismatch was significantly lower in group I and there were more ABO incompatible kidney transplantation in group II compared to the other groups. There were 4 (2.3%), 3 (1.9%), and 3 (5.4%) cases of mortality in group I, group II, and group III, respectively (p= 0.352). There was no significant difference in the one, three, and five years patient survival among groups (p=0.444). There was no significant difference in the biopsy-proven acute rejection between the three groups. Clinical rejection and DGF occurred at a high rate in group II compared to group I and group III, but there was no statistically significant difference between the three groups.
We conclude that both offspring and spousal living donor transplants have similar patient and graft survival and can be considered whenever feasible for female recipients with multiple donor options.