Kidney transplantation of living unrelated donor-recipient combinations.
BACKGROUND
According to the Japanese renal transplant registry in 2009, there were 1123 living kidney transplantations (LKT), including 35% from spouses (husband/wife). Up to the present in Japan, biologically living unrelated donors (LURD) are most frequently spouses. This study summarized our experience with LURD, especially spousal, kidney transplantation.


METHODS
We performed 112 cases of LKT between April 2003 and March 2011, including 44 (39%) from spouses and two from other LURD. The other 66 cases received kidneys from living related donors (LRD). We divided the patients into two groups: 44 patients (group 1) received kidneys from spouses (LURD) and 66 (group 2) from LRD. During the induction phase, tacrolimus or cyclosporine, mycophenolate mofetil, and methylprednisolone were prescribed for immunosuppression. Basiliximab was administered on postoperative days 0 and 4. In ABO-incompatible LKT, plasmapheresis was performed to remove anti-AB antibodies prior to LKT; splenectomy or rituximab administration, at the time of or before LKT.


RESULTS
Among group 1, one patient died with a functioning graft and one lost her graft. Among group 2, one patient died with a functioning graft and one lost his graft. The incidences of an acute rejection episode were 31.8% and 24.2% in groups 1 and 2, respectively. There were three cases of antibody-mediated rejection in group 1. No patient experienced a lethal infectious complication.


CONCLUSIONS
Our results demonstrated that spousal LKT (LURD) was equivalent to LKT from LRD. In response to the shortage of deceased donors, LKT between married couples and from ABO-incompatible donors will spread in Japan.
Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Tochigi, Japan. nob-ishi@jichi.ac.jp
N
N
Ishikawa
T
T
Yagisawa
Y
Y
Sakuma
T
T
Fujiwara
T
T
Kimura
A
A
Nukui
M
M
Yashi
D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007564:Japan; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012042:Registries; D013156:Splenectomy; D018454:Spouses; D013997:Time Factors; D016896:Treatment Outcome; D061349:Unrelated Donors / Q000600:supply & distribution*; D055815:Young Adult
D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents