title: Living-unrelated donor renal transplantation: an alternative to living-related donor transplantation?
abstract: BACKGROUND
  An increasing number of living-unrelated, kidney donor transplants are being performed in our unit. We present a comparison of living-unrelated (LURD) and living-related donor (LRD) renal transplant outcomes and analyse influencing factors.
  
  
  METHODS
  We retrospectively analysed the outcome of all living-donor renal transplants performed at our centre from 1993 to 2004. The parameters studied included patient and graft survival, functioning status of grafts (determined by estimated GFR) at last follow-up and any rejection episodes. Multivariate analysis was performed for recipient and donor age, ethnicity, HLA matching and re-transplants.
  
  
  RESULTS
  A total of 322 live donor kidney transplants (LRD, n = 261; LURD, n = 61) were carried out over this period. Mean recipient age was 28 +/- 16 years in the LRD group and 48 +/- 12 years in LURD, while mean age of the donors was 43 +/- 11 years and 48 +/- 10 years, respectively. Caucasians constituted 80% of all the living donors. Amongst LRD, parents were the commonest (58%) donors followed by siblings (35%). In LURD, 80% were spouses. A total of 33 grafts failed, 30 in LRD (11%) and 3 in LURD (5%). Thirteen patients died, 11 (4.2%) in LRD (7 with functioning graft) and 2 (3.3%) in LURD (1 with functioning graft). Acute rejections occurred in 41% recipients in LRD and 35% in LURD (P = 0.37). Estimated GFR was lower in LURD than in LRD (49 +/- 14 versus 59 +/- 29 ml/min/1.73 m(2); P = 0.032). One- and 3-year patient survival for LRD and LURD was 98.7% and 96.3% and 97.7% and 95%, respectively (P = 0.75). One- and 3-year graft survival was equivalent at 94.8% and 92.3% for LRD, and 98.4% and 93.7% for LURD, respectively (P = 0.18).
  
  
  CONCLUSIONS
  Outcome of LRD and LURD is comparable in terms of patient and graft survival, acute rejection rate and estimated GFR despite differences in demographics, HLA matching and re-transplants of recipients.
authors.affiliation: Department of Transplantation, Guy's and St Thomas' Hospitals & GKT School of Medicine, London, UK.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Ahmad
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
authors.forename: Mohammad Shamim
authors.initials: MS
authors.lastname: Khan
authors.forename: Francis
authors.initials: F
authors.lastname: Calder
authors.forename: Nizam
authors.initials: N
authors.lastname: Mamode
authors.forename: John
authors.initials: J
authors.lastname: Taylor
authors.forename: Geoff
authors.initials: G
authors.lastname: Koffman
mesh_terms: D000328:Adult; D005190:Family; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy; D007674:Kidney Diseases / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods* / Q000401:mortality; D019520:Living Donors / Q000145:classification*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018454:Spouses; D015996:Survival Rate; D016896:Treatment Outcome