PERSPECTIVES IN RENAL MEDICINE Living unrelated donor kidney transplantation

Living unrelated donor kidney transplantation. survival rates were attributed to the fact that kidneys Background. Living unrelated donors remain an underutifrom living donors were uniformly healthy. lized resource, despite their high graft survival rates. In this Even then, evidence of unexpectedly high graft surarticle, we updated the long-term results of more than 2500 vival rates in living unrelated donor transplants had been living unrelated donor transplants performed in the United States. mounting for years [2–8]. For example, two Korean cenMethods. Between 1987 and 1998, 1765 spouse, 986 living ters with the largest numbers of such cases at the time unrelated, 27,535 living related, and 86,953 cadaver donor reported that their five-year graft survival rates for living grafts were reported to the United Network for Organ Sharing unrelated donor transplants were near 80%, indistinKidney Registry. Kaplan–Meier curves compared graft survival rates in stratified analyses, and a log-linear analysis adjusted guishable from their living related donor counterparts donor-specific outcomes for the effects of 24 other transplant [3, 7]. Brain death was not legally accepted in Korea, so factors. except for a few non–heart-beating cadaver donor cases, Results. The long-term survival rates for both spouse and living unrelated transplants were essentially the same (5-year spouses and other living unrelated individuals were the graft survivals of 75 and 72% and half-lives of 14 and 13 years, only organ source when relatives were unavailable. In respectively). The results were similar to that for parent donor countries that have established brain death laws, the acute grafts (5-year graft survival 5 74% and half-life 5 12 years) shortage of cadaveric organs has spurred the growth of and were significantly (P 5 0.003) better than cadaver donor grafts (5-year graft survival 5 62% and half-life 5 9 years). living unrelated kidney transplants as well. After adjusting for the presence of transplant factors known Despite the evidence for excellent outcomes, living to influence survival rates, recipients of living unrelated donor unrelated donors remain an underutilized resource. In kidney transplants still had superior outcomes compared with particular, only a small fraction of the estimated 6000 cadaver transplants. Conclusions. Living unrelated kidney donors represent the potential spouse donors per year have been actual dofastest growing donor source in the United States and provide nors in the United States [1, 9]. Besides issues of coerexcellent long-term results. Encouraging spouses to donate cion, morbidity, and mortality [10], another impediment could remove nearly 15% of the patients from the UNOS waiting list, effectively increasing the number of available cato living unrelated donation has been the argument that daveric organs. less restrictive recipient selection criteria coupled with