Unrelated living donor kidney transplantation

Abstract

Since 1966, we have performed 41 renal transplants from unrelated living donors (ULD), 39 of which were "emotionally related". All donor-recipient pairs included in the present series were AB0-compatible. Recipients included 37 with primary and 4 with secondary transplants; 2 of the latter were diabetics. We compared these results to those of 41 recipients of cadaver donor kidneys matched for age, sex, immunosuppressive regimen, rank, and year of transplant, focusing our attention on the subgroups of patients under cyclosporin A (CyA) therapy (n = 24). We found that ULD transplantation was as successful as cadaver transplantation with good HLA matching: at 3 years, graft survival rates were 81% in ULD versus 86% in the control group under CyA. Moreover, grafts from ULD functioned more rapidly (no post-transplant dialysis and 70% of the patients with serum creatinine below 2 mg/dl within 3 days post-transplant). Graft tolerance was equivalent in both groups (50% of the patients experienced no rejection). We conclude that despite poor HLA matching, ULD transplantation with CyA as the basic immunosuppressive agent offers good results: benefiting from the quality of living donor kidney grafts, it helps to alleviate the persistent shortage of cadaver donors.

Increasing the Pool of Transplantable Kidneys Through Unrelated Living Donors and Living Donor Paired Exchanges

“…Several considerations support this view: 1) as noted above, the results of kidney transplantation from genetically unrelated living donors are excellent (Fig. 1) (5); 2) the risk of kidney donation is independent of the donor's relationship to the recipient and therefore not greater for ERDs than for genetically related donors (GRDs); 3) pressure to donate should be no greater (and may sometimes be less) for ERDs than for GRDs (15,17,20); 4) the bonds motivating ERDs may be as strong or stronger than those motivating GRDs (16,19,22,23); 5) follow‐up studies of ERDs have shown that the great majority of those studied are glad they donated and would make the same choice again (9,14); 6) as is true for GRDs, many ERDs benefit psychologically from donating (9,14,16,19,22); 7) surveys of the public have shown that most respondents would be willing to donate a kidney to a spouse and many to a close friend (24–26); and 8) commercialism is no more of an issue for ERDs than it is for GRDs.…”

“…Many authors have argued cogently that if genetic relatives are often ethically acceptable kidney donors, then emotional relatives should be too (8,9,13–23). Several considerations support this view: 1) as noted above, the results of kidney transplantation from genetically unrelated living donors are excellent (Fig.…”

The History of Kidney Transplantation: Past, Present and Future (with Special References to the Belgian History)

“…Kidney survival in 56 parental and 26 cadaver graft in pediatric recipients during the CsA era (1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994). Difference between the two curves reaches > 30% at 10 years (Malaise et al, 1995) 40 .…”

“…17). Even if one year results improved with the CsA use, the slope of the curves were parallel (Malaise et al, 1995) 40 . The children experience underlined the advantages of LD over the DBD renal transplantation.…”

Expanding the Donor Pool

“…Altruistic emotionally related donation is currently accepted by most of the North American renal transplant centers, mainly after favorable results of living unrelated kidney donation have been reported (75)(76)(77)(78)(79)(80)(81)(82) and recently confirmed by a review of data from the UNOS Renal Transplant Registry (83).…”