Kidney Transplantation from Living Unrelated Donors

  1. Ricardo Sesso, MD, MSc;
  2. Michael J. Klag, MD, MPH;
  3. Meide S. Ancao, MD;
  4. Paul K. Whelton, MD, MSc;
  5. Alexander Seidler, PhD;
  6. Daniel Sigulem, MD; and
  7. Oswaldo L. Ramos, MD

    Abstract

    ▪ Objective: To compare patient and graft survival of recipients of kidneys from living, unrelated donors (LUDs); cadaveric donors; and living, related donors (LRDs) matched for zero (mismatched), one, or two (identical) haplotypes.

    ▪ Design: Cohort study.

    ▪ Setting: Sixty-three renal transplantation centers affiliatedfiliated with the Brazilian Transplantation Registry (accounting for more than 95% of the transplantation activity in Brazil).

    ▪ Patients: Patients having renal transplantation between January 1987 and March 1991. Of 2892 patients, 165 (6%) received transplants from LUDs; 964 (33%), from cadaveric donors; 183 (6%), from zero haplotype, HLA-matched LRDs; 1259 (44%), from one haplotypematched LRDs; and 321 (11%), from two haplotype-matched LRDs.

    ▪ Measurements: Patient and graft survival. Patients were followed for an average of 15.8 months.

    ▪ Results: After adjustment for age, race, diagnosis of primary disease, history of previous transplantation, cyclosporine use, and number of transplants from LUDs per center, patient survival did not differ statistically for recipients of kidneys from LUDs and recipients of cadaveric kidneys (risk ratio [RR], 1.16; 95% CI, 0.68 to 1.98). Little difference was seen between the adjusted death rate for recipients of zero haplotype-matched LRDs and recipients of cadaveric kidneys (RR, 1.13; CI, 0.69 to 1.87). Similarly, in a multivariate analysis, recipients of kidneys taken from LUDs and zero haplotype-matched LRDs had a risk for graft failure that did not differ statistically from that of cadaveric kidney recipients (RR, 0.74; CI, 0.45 to 1.22 and RR, 0.82; CI, 0.53 to 1.25, respectively).

    ▪ Conclusions: Graft survival for recipients of kidneys from LUDs is similar to that from zero haplotype-matched LRDs and is at least as good as that achieved with cadaveric transplants.

    Article and Author Information

    • From Escola Paulista de Medicina, Sao Paulo, Brazil; Brazilian Renal Transplantation Registry; and The Johns Hopkins University, Baltimore, Maryland. For current author addresses, see end of text.

    • Grant Support: By a grant from the Rockefeller Foundation (International Clinical Epidemiology Network), Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, Brazil), and from the Institute Paulista de Estudos e Pesquisas em Nefrologia e Hipertensao, Brazil. Dr. Sesso is a recipient of a postdoctoral fellowship grant from the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, Brazil). Dr. Klag is an established investigator of the American Heart Association.

    • Requests for Reprints: Ricardo Sesso, MD, Escola Paulista de Medicina, Division of Nephrology, Rua Botucatu 740, Sao Paulo, SP, 04023, Brazil.

    • Current Author Addresses: Drs. Sesso and Ramos: Division of Nephrology, Escola Paulista de Medicina, Rua Botucatu 740, Sao Paulo, SP, 04023, Brazil.

      Drs. Klag, Whelton, and Seidler: The Johns Hopkins Health Institutions, 600 North Wolfe St., Carnegie 292, Baltimore, Maryland, 21287.

      Drs. Ancao and Sigulem: Health Informatics Center, Escola Paulista de Medicina, Rua Botucatu 740, Sao Paulo, SP, 04023, Brazil.

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    1. Ann Intern Med December 15, 1992 vol. 117 no. 12 983-989
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