LIVING-RELATED AND UNRELATED DONORS FOR KIDNEY-TRANSPLANTATION - A 28-YEAR EXPERIENCE

Objective The objective of this study was to analyze a single center's 28-year experience with 1000 living donor transplants. Summary Backgr ound Data The number of potential renal transplant recipients far exce eds the number of cadaveric donors. For this reason, living related do nors (LRDs) and, more recently, living unrelated donors (LURDs) have b een used to decrease the cadaveric donor shortage. Methods From Novemb er 15, 1966, until August 5, 1994, 1000 living donor transplants were performed; 906 were living related and 94 were living unrelated transp lants. Results were divided into precyclosporine (1966-1986, era I) an d cyclosporine (1986-1994, era II) eras. Patient and graft survivals w ere compared between diabetic and nondiabetic recipients, between LRDs and LURDs, and according to human leukocyte antigen (HLA) matching. D onor mortality, morbidity, and postoperative renal function were also analyzed. Results The 5-, 10-, and 20-year graft survivals were 78.8%, 64.8%, and 43.4%, respectively. Patient and graft survival improved i n era II (patient = 87.0% vs. 81.7%, p = 0.03; graft = 72.9% vs. 67.7% , p = 0.04). Nondiabetic patient and graft survivals were better than diabetic patient survivals in both eras. However, diabetic patient sur vival improved in era II (78.0% vs. 66.9%, p = 0.04). In era II, HLA-i dentical recipients had better graft survival than haploidentical or m ismatched recipients (91.7% vs. 67.3% and 66.1%, p = 0.01). No differe nce between haploidentical LRDs and LURDs was seen. One donor death oc curred in 1970, and 17% of donors developed postoperative complication s. Conclusion Living related and unrelated renal donation continues to be an important source of kidneys for patients with end-stage renal d isease.