Living unrelated donor kidney transplantation

Background. Living unrelated donors remain an underutilized resource, despi te their high graft survival rates. In this article, we updated the long-te rm results of more than 2500 living unrelated donor transplants performed i n the United States. Methods. Between 1987 and 1998, 1765 spouse, 986 living unrelated, 27,535 l iving related, and 86,953 cadaver donor grafts were reported to the United Network for Organ Sharing Kidney Registry. Kaplan-Meier curves compared gra ft survival rates in stratified analyses, and a log-linear analysis adjuste d donor-specific outcomes for the effects of 24 other transplant factors. Results. The long-term survival rates for both spouse and living unrelated transplants were essentially the same (5-year graft survivals of 75 and 72% and half-lives of 14 and 13 years, respectively). The results were similar to that for parent donor grafts (5-year graft survival = 74% and half-life = 12 years) and were significantly (P = 0.003) better than cadaver donor g rafts (5-year graft survival = 62% and half-life = 9 years). After adjustin g for the presence of transplant factors known to influence survival rates, recipients of living unrelated donor kidney transplants still had superior outcomes compared with cadaver transplants. Conclusions. Living unrelated kidney donors represent the fastest growing d onor source in the United States and provide excellent long-term results. E ncouraging spouses to donate could remove nearly 15% of the patients from t he UNOS waiting list, effectively increasing the number of available cadave ric organs.