title: Living-unrelated renal transplantation: results in 40 patients.
abstract: Kidney transplantation for the treatment of end-stage renal disease has been limited by an inadequate number of donor organs. Because of the enormous impact kidney transplantation can have for patients, the authors have performed 40 living-unrelated donor renal transplantations using a donor-specific transfusion protocol since 1981. Ten additional patients were entered but became sensitized. Donors included 23 wives, seven husbands, six friends, and four individuals related by marriage. Type I diabetes was the most common indication for transplantation (45%). Despite 36 rejections in 24 patients (27 of 36 [75%] in the early postoperative period), only two grafts failed because of rejection. Twenty-one of these rejections responded to high-dose prednisone alone; the remainder required antilymphocyte globulin therapy or plasmapheresis. Sixteen patients had no acute rejections. Three other grafts were lost, including two deaths: one myocardial infarction (with a functioning graft), and one death secondary to a postoperative cecal perforation. One graft was lost from infarction after percutaneous nephrostomy placement. Of 40 grafts, 34 were functioning with a mean serum creatinine of 1.7 mg/dL (at a mean follow-up time of 27 months). Actuarial patient and graft survival were 94% and 89%, respectively, at 3 years. Living-unrelated renal transplants are an acceptable alternative to cadaver transplants, with excellent graft and patient survival.
authors.affiliation: Department of Surgery, School of Medicine, University of Wisconsin, Madison.
authors.forename: J D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: H W
authors.initials: HW
authors.lastname: Sollinger
authors.forename: M
authors.initials: M
authors.lastname: Kalayoglu
authors.forename: R J
authors.initials: RJ
authors.lastname: Stratta
authors.forename: A M
authors.initials: AM
authors.lastname: D'Alessandro
authors.forename: M J
authors.initials: MJ
authors.lastname: Armbrust
authors.forename: F O
authors.initials: FO
authors.lastname: Belzer
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D001803:Blood Transfusion; D005069:Evaluation Studies as Topic; D005260:Female; D006084:Graft Rejection / Q000187:drug effects; D006648:Histocompatibility; D006801:Humans; D007114:Immunization / Q000379:methods; D016030:Kidney Transplantation; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D014019:Tissue Donors
chemical_list: D001379:Azathioprine; D011241:Prednisone