Living-unrelated kidney donation: a single-center experience

For 140 consecutive renal transplants performed from January 1995 to Octobe r 1997, 25 (18%) were from living-unrelated donors (15 women, 10 men, aged 25-63, mean 43 yr). All donors had pretransplant imaging evaluation of rena l anatomy following renal function assessment (minimal creatinine clearance 75 cm(3)/min). Admission to the hospital on the day of donation preceded n ephrectomy under general anesthesia using an anterior flank, extra-retroper itoneal approach (no rib resection). Post-operative epidural pain control w as used for all but 1 donor. The 25 kidney donors were hospitalized for 2 ( n = 1), 3 (n = 12), 4 (n = 7), or 5-8 d (n = 5) (average 3.9 d) and had a m ean hospitalization charge of $15501 (range $10808-$29579). One intra-opera tive hemorrhage required transfusion; 1 late neural-related pain syndrome r equired outpatient wound exploration. Two kidneys were lost: a husband reci pient from repetitive acute rejections at 3 months; a friend recipient from chronic rejection at 2.5 yr; both await cadaver transplant. The other 23 k idneys are functioning with a mean serum creatinine of 1.8 (range 1.0-3.3) at 3-36 months (patient survival 100%; graft survival 92%). While most dono rs were spouses (8 husbands and 10 wives), friends, distant cousins, in-law s, and adoptive relatives did well as donors and recipients. Transplantatio n may increase by 20% or more at centers which encourage broad application of living donor nephrectomy.