Outcomes of Spousal versus Parental Donor Kidney Transplants: A Comparative Study.

INTRODUCTION: Parents and spouse constitute 70% of organ donors in India. Some centres use induction immunosuppression (IS) for all spousal transplants considering it as an immunologically high risk. This study was designed to compare the outcomes of transplant recipients who received parental donors (PDs) and spousal donors (SDs) without any induction IS. METHODS: It was a retrospective study conducted at a tertiary care hospital in South India. Adults aged 18 years or above who underwent renal transplantation from a SD or PD between January 2006 and December 2016 were included in the study. RESULTS: Our study included 154 patients with PDs and 75 patients with SDs. The mean recipient age of the PD group was 27.79 ± 6.85 years and of the SD group was 45.62 ± 7.96 years (P < 0.001). However, the follow-up period was significantly higher for the PD group (P < 0.05). There was no significant difference between acute rejection, patient loss, mean survival, graft survival (uncensored), and death censored graft survival between two groups. CONCLUSION: The outcomes of immunologically low-risk transplant recipients who have received PD and SD are similar and induction immunosuppression can be avoided in these patients.

Outcomes of spousal versus related donor kidney transplants: A comparative study.

This study was designed to compare the outcomes of spousal donor (SD) with related donor (RD) kidney transplants performed at our center between January 2010 and October 2012. A total of 323 adult, ABO-compatible kidney transplants (SD 150 [46.4%], RD 173 [53.6%]) were included. Data on outcomes at 6 months post-transplant was collected retrospectively (2010-2011) and prospectively (January-October 2012). Majority of the donors (SD 88%, RD 72.2%) were females. In the SD group, donors were younger (SD 35.6 ± 8.2 years, RD 45.2 ± 11.5 years; P < 0.0001), whereas recipients were older (SD 42.2 ± 8.3 years, RD 30.0 ± 9.5 years; P < 0.0001). A significantly higher proportion of patients in the SD group were given induction therapy (43% vs 12%; P < 0.001). Biopsy proven acute rejections were more common in the RD group (16% vs 28.3%; P = 0.01). Majority (80.8%) of the acute rejections occurred in the first 2 weeks post-transplant in both groups. Isolated acute cellular rejections (ACRs) and isolated antibody mediated rejections constituted 50% and 25% of rejection episodes in both groups, whereas the remainder had histological evidence of both. The proportion of steroid responsive ACRs was similar in both groups (SD 83.3%, RD 65.4%; P = 0.2). The number of patients with abnormal graft function at the end of the study was higher in the RD group (2.3% vs. 12.3%; P = 0.001). Patient survival and infection rates were similar in the two groups. We conclude that short-term outcomes of SD transplants are not inferior to RD transplants. Lesser use of induction therapy in the RD group may explain the poorer outcomes as compared to the SD group.

The Results of Spousal Donor Kidney Transplantation Via Exchange Donor Program and Direct Spousal Donor Kidney Transplantation in Living Donor Kidney Transplantation: Single Center Experience / 대한이식학회지

BACKGROUND: The shortage of living related and deceased donor groups is one of the major problems of kidney transplantation. We examined the results of spouse and spousal exchange among living kidney transplantation. METHODS: Living donor kidney transplants at a single center between 1991 and 2005 were studied, retrospectively (n=593). We compared the graft survival rates of 24 spousal, 53 spousal exchange transplantations with those of 125 sibling, 142 other living related donor (LRD) or 249 other living unrelated donor (LURD) procedures. We analyzed graft survival rate, acute rejection rate among each groups. RESULTS: The 5, 10 year graft survival rates of spousal donor were 75.0%, 69.2%, those of other LURD and spousal exchange were 74.6%, 64.5% (P=0.80) and 86.6%, 84.8% (P=0.11), those of sibling and other LRD were 82.3%, 75.9% (P=0.37) and 75.7%, 65.4% (P=0.84). Spousal exchange donor were more good graft survival rates rather than other LRD and LURD (P=0.01, 0.01). Acute rejection rates of spousal donor were not significant difference among sibling, other LRD and LURD groups. But acute rejection rates of spousal exchange donor (22.6%) were lower than spousal (45.8%) and other LURD (38.7%) (P=0.04, 0.04). In the multivariate analysis of donor groups, other LRD and LURD groups were associated with a high relative odds of graft survival (odds ratio 2.88+/-0.38 (P=0.02), 2.35+/-0.37 (P=0.01)) compared to spousal exchange donor groups. CONCLUSIONS: The spousal exchange donors had more good graft survival rates than other LRD and LURD groups and spousal donors were as good as other living donors. We expect that the spousal and spousal exchange transplantations are one of the good programs for donor pool expansion.

Clinical Outcomes of Spousal Donor Kidney Transplantation: Single Center Experience / 대한이식학회지

BACKGROUND: The supply of deceased donors is limited in Korea and most of kidney transplantations are performed using living related or unrelated donors. In this study, we investigated the clinical characteristics and outcomes of spousal donor kidney transplantation at our center. METHODS: From January 2000 to August 2008, we performed 909 cases of kidney transplantations. In this study, 475 one-haplomatch living-related donor (LRD) and 50 spousal donor kidney transplantations were retrospectively analyzed. We compared the outcomes of spousal donor group with those of one-haplomatch LRD group. We also compared the outcomes of husband-to wife with those of wife-to-husband subgroup. RESULTS: The number of Human leukocyte antigen (HLA) mismatch was significantly larger in spousal group (3.3+/-1.2) than in LRD group (2.7+/-0.7). The proportion of tacrolimus use was higher in spousal group (72.0%) than in LRD group (26.6%). The incidence rate of delayed graft function was higher in spousal group (4.0%) than in LRD group (0.4%). There was no significant difference in the incidence of acute rejection between the two groups. Graft survival rates in spousal group (98.0% at 1 year and 91.5% at 5 year) were comparable to those in LRD group (99.6% at 1year and 98.7% at 5 year) (P=0.321). There were no significant differences in the incidence of acute rejection and graft survival rates between the subgroups (husband-to-wife vs. wife-to- husband). CONCLUSIONS: We achieved excellent outcomes by using spousal donor as an option to reduce the donor organ shortage.

Outcomes of Kidney Transplantation from Spousal Donors: Comparison with Kidney Transplantation from Living-related Donors / 대한신장학회잡지

BACKGROUND: Although transplantation is the best treatment for many people with end-stage renal disease, the gap between the number of organs and the number of potential recipients continues to widen. In addition to living-related individuals, the primary source of donor kidney, the severe organ shortage has led to consideration of genetically unrelated but emotionally related persons as donor candidates. The aim of this study was to compare the results of spousal kidney transplantation with those of living-related kidney transplantation and to analyze the characteristics of spousal kidney transplantation. METHODS: Clinical data were retrospectively analyzed from 21 patients with spousal kidney transplantation and 205 patients with living-related kidney transplantation. Cumulative renal allograft survival was compared between the two groups using Kaplan-Meier curve and log-rank test. Subgroup analysis was done within the patients with spousal kidney transplantation. RESULTS: The patients were significantly older in spousal group (43.7+/-7.8 years) than in living-related group (36.2+/-10.8 years). Donor age was also significantly higher in spousal group (43.0+/-8.4 years) than in living-related group (39.8+/-13.9 years). The number of HLA mismatch was significantly larger in spousal group (3.79+/-1.03) than in living-related group (2.60+/-1.21). The episodes of acute rejection occurring within a year after the transplantation were more frequent in spousal group (5/21) than in living-related group (13/205). Kaplan-Meier curves for cumulative survival of renal allograft revealed no difference between spousal group and living-related group. Renal allograft survival rates in spousal group were 85.2% at 1 year, 75.2% at 5 years, and 67.7% at 10 years after the transplantation. In living-related group, renal allograft survival rates were 96.6% at 1 year, 85.9% at 5 years, and 69.9% at 10 years after the transplantation. Within the patients with spousal kidney transplantation, cumulative renal allograft survival was superior in cases with absent acute rejection, husband-to-wife transplantation, and the number of HLA mismatch less than 5. CONCLUSION: Spousal kidney transplantation shares comparable results with living-related kidney transplantation despite older age, poorer HLA matching and a higher rate of acute rejection. Spousal donor transplants could be a real alternative especially when the donors are husband and the number of HLA mismatch is less than 5.