Successful long-term outcome with 0-haplotype-matched living-related kidney donors

Jon W. Jones, Kristen J. Gillingham, David E.R. Sutherland, William D. Payne, David L. Dunn, Paul F. Gores, Rainer W.G. Gruessner, John S. Najarian, Arthur J. Matas

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

The waiting list for cadaver kidney transplantation continues to grow. Yet there has been little increase in the number of living-donor transplants. At many centers, willing relatives are turned down as potential donors because of poor HLAABDR matching with the recipient. It has been our policy to accept the 0-haplo-type-match (O-HTM) living-related donor. We studied long-term (6-year) outcome of 0-HTM transplants compared with the outcome of transplants from 1- and 2-HTM recipients and from cadaver donors. Since 1984, 352 adults have received primary living-related renal transplants, and had a minimum of 1 year of follow-up: 92 2-HTM, 216 1-HTM, and 44 O-HTM. In the same period and with the same follow-up, 362 adults have received primary cadaver (CAD) renal transplants. Immunosuppression consisted of cyclosporine, azathioprine, and prednisone (triple therapy) for living-donor and sequential therapy for CAD recipients. ABDR match (mean±SD) for 0 HTM was 1.3±8; CAD, 2.0±1.6; % peak panel-reactive antibodies (PRA) for 0 HTM was 1.2±5.3; 1 HTM, 6.7±20; 2 HTM, 7.5±21; CAD, 15.5±30. The percentage of PRA at the time of transplant for 0 HTM was .7 ± 4.4; 1 HTM, 4.1 ± 1.6; 2 HTM, 6±18; CAD, 7.2±20. While the number of ABDR matches was significantly fewer for 0 HTM than for the other groups, the % PRA at transplant and the peak % PRA were less in the O-HTM group. Other demographics were not significantly different. Patient survival was significantly lower in the CAD group vs. 2-HTM recipients (P<.05). The living-related grafts had significantly greater survival than the CAD grafts (P<.05), but there was no significant difference between 0-, 1-, and 2-HTM graft survival. The most common causes of graft loss in all groups were death and chronic rejection.In our experience, the long-term graft survivals of 0-HTM and 1-HTM transplants are the same, and both are superior to CAD results, using 0-HTM living-related donor transplants should be continued and encouraged.

Original languageEnglish (US)
Pages (from-to)512-515
Number of pages4
JournalTransplantation
Volume57
Issue number4
DOIs
StatePublished - Feb 1994

ASJC Scopus subject areas

  • Transplantation

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