A RETROSPECTIVE STUDY OF KIDNEY-TRANSPLANT RECIPIENTS FROM LIVING UNRELATED DONORS

Due to the shortage of cadaveric organs, kidneys from living unrelated donors (LUD) are increasingly being used for transplantation. The lon g-term outcome for LUD recipients is not completely known. This study was undertaken to evaluate the long-term graft survival in LUD recipie nts and compare it with that of cadaver donor allograft recipients. Th ree hundred and sixty-four LUD and 3881 cadaveric kidney recipients we re evaluated using data obtained through the Brazilian Renal Transplan t Registry. Transplants performed between January 1, 1987, and June 30 , 1996, were eligible for analysis, Graft and patient survival were es timated by the Kaplan-Meier method. Sixty percent of the LUD were from spouses. The median duration of follow-up was 23.8 mo (0 to 117.2 mo) . Patient survival rates were not significantly different for LUD and cadaveric kidney recipients (69% [95% confidence interval (CI), 61.9 t o 76.1%] versus 73.2% [71 to 75.4%] at 5 yr; 69% [61.9 to 76.1%] versu s 60.6% [55.1 to 66.1%] at 9.6 yr). Graft survival rates for recipient s of LUD allografts were similar to those for cadaveric kidneys at 5 y r (50.1% [43.2 to 57%] versus 50.4% [48.1 to 52.8%]) and higher, altho ugh not significantly, at 9.6 yr (45.7% [37.7 to 53.7%] versus 32.7% [ 26.4 to 39%], respectively, P = 0.14). In a multivariate analysis usin g the Cox proportional hazards regression model, after adjusting for r ecipient age, race, history of previous transplantation, and year of t ransplantation, the risk of graft failure was 16% (95% CI, -3% to 31%) lower for LUD than cadaveric recipients. We conclude that LUD are an excellent alternative to cadaveric kidney donors. The long-term patien t and graft survival rates for recipients of LUD allografts are at lea st as good as those for recipients of cadaveric kidneys.