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Volume 333:333-336 August 10, 1995 Number 6 Next

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ABSTRACT

Background In the United States, increasing numbers of persons are donating kidneys to their spouses. Despite greater histoincompatibility, the survival rates of these kidneys are higher than those of cadaveric kidneys. We examined the factors influencing the high survival rates of spousal-donor kidneys.

Methods Kidney-transplant data from the United Network for Organ Sharing Renal Transplant Registry were used to calculate graft-survival rates with Kaplan–Meier analysis.

Results The three-year survival rates were 85 percent for kidneys from 368 spouses, 81 percent for kidneys from 129 living unrelated donors who were not married to the recipients, 82 percent for kidneys from 3368 parents, and 70 percent for 43,341 cadaveric kidneys. The three-year survival rate for wife-to-husband grafts was 87 percent, which was the same as for husband-to-wife grafts if the wife had never been pregnant. If the wife had previously been pregnant, the three-year graft-survival rate was 76 percent (P = 0.40). The three-year graft-survival rate among recipients of spousal grafts who did not receive transfusions preoperatively was 81 percent, as compared with 90 percent for recipients who received 1 to 10 transfusions preoperatively (P = 0.008). The superior survival rate of grafts from unrelated donors could not be attributed to better HLA matching, white race, younger donor age, or shorter cold-ischemia times, but might be explained by damage due to shock before removal in 10 percent of the cadaveric kidneys.

Conclusions Spouses are an important source of living-donor kidney grafts because, despite poor HLA matching, the graft-survival rate is similar to that of parental-donor kidneys. This high rate of survival is attributed to the fact that the kidneys were uniformly healthy.

Source Information

From the Department of Surgery, University of California, Los Angeles, School of Medicine, 950 Veteran Ave., Los Angeles, CA 90095, where reprint requests should be addressed to Dr. Terasaki.

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• Miller, L. W., Dai, E., Nash, P., Liu, L., Icton, C., Klironomos, D., Fan, L., Nation, P. N., Zhong, R., McFadden, G., Lucas, A. (2000). Inhibition of Transplant Vasculopathy in a Rat Aortic Allograft Model After Infusion of Anti-Inflammatory Viral Serpin. Circulation 101: 1598-1605 [Abstract] [Full Text]  
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• Sund, S., Reisater, A. V., Fauchald, P., Bentdal, O., Hall, K. S., Hovig, T. (1999). Living donor kidney transplants: a biopsy study 1 year after transplantation, compared with baseline changes and correlation to kidney function at 1 and 3 years. Nephrol Dial Transplant 14: 2445-2454 [Abstract] [Full Text]  
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• Heeger, P. S., Greenspan, N. S., Kuhlenschmidt, S., Dejelo, C., Hricik, D. E., Schulak, J. A., Tary-Lehmann, M. (1999). Pretransplant Frequency of Donor-Specific, IFN-{gamma}-Producing Lymphocytes Is a Manifestation of Immunologic Memory and Correlates with the Risk of Posttransplant Rejection Episodes. J. Immunol. 163: 2267-2275 [Abstract] [Full Text]  
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• Nicholson, M. L, Bradley, J A. (1999). Renal transplantation from living donors. BMJ 318: 409-410 [Full Text]  
• Mathieson, P., Jolliffe, D., Dudley, C., Hamilton, K., Lear, P. (1999). The spouse as a kidney donor: ethically sound?. Nephrol Dial Transplant 14: 46-48 [Abstract]  
• HALLORAN, P. F., MELK, A., BARTH, C. (1999). Rethinking Chronic Allograft Nephropathy: The Concept of AcceleratedSenescence. J. Am. Soc. Nephrol. 10: 167-181 [Full Text]  
• Shaffer, D., Sahyoun, A. I., Madras, P. N., Monaco, A. P. (1998). Two Hundred One Consecutive Living-Donor Nephrectomies. Arch Surg 133: 426-431 [Abstract] [Full Text]  
• Poston, R. S. Jr, Billingham, M. E., Pollard, J., Hoyt, E. G., Robbins, R. C. (1997). Effects of Increased ICAM-1 on Reperfusion Injury and Chronic Graft Vascular Disease. Ann. Thorac. Surg. 64: 1004-1012 [Abstract] [Full Text]  
• Chertow, G. M. (1997). Nephrology. JAMA 277: 1872-1873  
• Hauptman, P. J., O'Connor, K. J. (1997). Procurement and Allocation of Solid Organs for Transplantation. NEJM 336: 422-431 [Full Text]  
• Walker, J. D (1996). Donation by living donors is effective for recipient and safe for donor. BMJ 312: 1358-1358 [Full Text]  
• (1995). KIDNEY TRANSPLANTS FROM LIVING UNRELATED DONORS. JWatch General 1995: 4-4 [Full Text]  
• Soulillou, J.-P. (1995). Kidney Transplantation from Spousal Donors. NEJM 333: 379-380 [Full Text]