Survival in kidney transplantation from living donors: a single-center experience

Outcome of Husband-to-Wife Kidney Transplantation With Mutual Children: Single Center Experience Using T Cell-Depleting Induction and Review of the Literature

Few data on husband-to-wife transplantations with mutual children (H2W) exist in the current era. We investigated the outcome of H2W transplantations (n = 25) treated with T cell-depleting induction compared to women with prior pregnancies also receiving their first HLA-mismatched kidney transplant, but from a different donor source: (i) other living donor (n = 52) and (ii) deceased donor (n = 120). Seventy-four percent of the women had ≥2 pregnancies; median follow-up time was 5 years. Death-censored allograft survival was significantly lower in the H2W group compared to the other two groups (p = 0.03). Three of four graft losses in the H2W group were due to rejection. 5-year patient survival in the H2W group was high and similar compared to the other living donor group (100 vs. 98%; p = 0.28). The incidence of (sub)clinical antibody-mediated rejection was higher in the H2W group (36 vs. 20 vs. 18%) (p = 0.10). The frequency of infections was similar among the three groups. No immunological parameter was predictive for rejection or graft loss in H2W transplantations. In conclusion, H2W transplantation is a valuable option, but associated with a higher risk for allograft loss due to rejection despite T cell-depleting induction. Further research is required for better risk prediction on an individual patient level.

Living related kidney transplantation in Libya: a single center experience

OBJECTIVE

The aim of this study was to establish a successful living related kidney transplantation program in Libya and to bring down health care costs in management of patients with end-stage renal disease.

PATIENTS AND METHODS

Since the transplantation program was launched on August 17, 2004, 135 patients have been transplanted up to August 17, 2007. The donors and recipients were screened prior to transplantation. Our immunosuppressive protocol was cyclosporine-based. Both donors and recipients were followed in the transplant outpatient clinic.

RESULTS

Among 135 accepted pairs, 133 cases (98.5%) were genetically related donors and recipients and 2 cases were emotionally related. Mean donor age was 37 +/- 9.5 years (range, 18-56 years). Recipient age was significantly lower, namely, 37 +/- 13.6 years (range, 7-67 years). Among the recipients, 95 (70.4%) were males and 40 (29.6%) females, while among the donors, 102 (75.6%) were males and 33 (24.4%) females. The most common donor-recipient relationship was brother-to-brother. There was no early or late surgical mortality among donors. Delayed graft function was observed in 3 patients (2.2%), acute rejection in 6 (4.4%), and posttransplantation infections in 8 (5.9%). Urinary tract infections were diagnosed in 6 patients (4.4%) and pneumonia in 3 (2.2%). Postsurgical complications included ureteric kink in 2 patients (1.5%) and an anastomotic urine leak in 4 (3.0%). At 36 months, graft survival was observed in 130 patients (96.3%) and patient survival in 126 (93.3%).

CONCLUSION

The Libyan National Organ Transplant Program has been successful with results comparable to international levels.

Comparison of spousal with other donor groups: Study of a single center

In coping with the shortage of living-related and cadaveric donor groups for renal transplantation, and in the fear of organ marketing, spousal donors are considered an invaluable potential source. Survival rates have been reported to be as high as even some related groups. This study evaluated 1039 renal transplantations up to 2003. Patient survival rates in different donor groups were determined using the Kaplan-Meier method. The 3-year patient survival rates were 93% for kidneys from 61 spouses; 92% for kidneys from 433 living-related donors; 91% for kidneys from 427 living-unrelated (excluding spouses) donors; and 90.5% for 118 cadaveric kidneys. Such results were consistent with many other reports which consistently showed that spousal donors were at least as good as living-related donors, representing a reliable source in cases of organ shortage. The high survival rate of spousal donors is probably related to their strong emotional support.

Rewarded gift for living renal donors

Although the waiting list for renal transplantation is growing from year to year, the participation of unrelated living donors in kidney transplantation remains controversial. Patients want to be transplanted as soon as possible, not years later. Nevertheless, cadaveric organ donation has not been able to meet the requirements for all patients in need. With a continuous shortage of organs, the use of living unrelated donors is likely to decrease patient suffering and waiting list mortality. The excellent short- and long-term results of living unrelated transplantation have stimulated physicians toward a wider use of this donor pool. Therefore, transplants from living donors, whether related or unrelated, may be proposed as a therapeutic option for end-stage renal disease patients. In this article we explain the necessity of compensating altruistic living donors as an incentive. It is concluded that living unrelated renal transplantation programs should be legalized and controlled by international and national transplant societies to prevent illegal trade and to provide better care for donors.