title: Alternative Living Kidney Donation Programs Boost Genetically Unrelated Donation.
abstract: Donor-recipient ABO and/or HLA incompatibility used to lead to donor decline. Development of alternative transplantation programs enabled transplantation of incompatible couples. How did that influence couple characteristics? Between 2000 and 2014, 1232 living donor transplantations have been performed. In conventional and ABO-incompatible transplantation the willing donor becomes an actual donor for the intended recipient. In kidney-exchange and domino-donation the donor donates indirectly to the intended recipient. The relationship between the donor and intended recipient was studied. There were 935 conventional and 297 alternative program transplantations. There were 66 ABO-incompatible, 68 domino-paired, 62 kidney-exchange, and 104 altruistic donor transplantations. Waiting list recipients (n = 101) were excluded as they did not bring a living donor. 1131 couples remained of whom 196 participated in alternative programs. Genetically unrelated donors (486) were primarily partners. Genetically related donors (645) were siblings, parents, children, and others. Compared to genetically related couples, almost three times as many genetically unrelated couples were incompatible and participated in alternative programs (P < 0.001). 62% of couples were genetically related in the conventional donation program versus 32% in alternative programs (P < 0.001). Patient and graft survival were not significantly different between recipient programs. Alternative donation programs increase the number of transplantations by enabling genetically unrelated donors to donate.
authors.affiliation: Department of Internal Medicine, Erasmus MC, s-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.
authors.forename: Rosalie A
authors.initials: RA
authors.lastname: Poldervaart
authors.affiliation: Department of Internal Medicine, Erasmus MC, s-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Laging
authors.affiliation: Department of Internal Medicine, Erasmus MC, s-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.
authors.forename: Tessa
authors.initials: T
authors.lastname: Royaards
authors.affiliation: Department of Internal Medicine, Erasmus MC, s-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Kal-van Gestel
authors.affiliation: Department of Internal Medicine, Erasmus MC, s-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.
authors.forename: Madelon
authors.initials: M
authors.lastname: van Agteren
authors.affiliation: Department of Internal Medicine, Erasmus MC, s-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.
authors.forename: Marry
authors.initials: M
authors.lastname: de Klerk
authors.affiliation: Department of Internal Medicine, Erasmus MC, s-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.
authors.forename: Willij
authors.initials: W
authors.lastname: Zuidema
authors.affiliation: Department of Internal Medicine, Erasmus MC, s-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.
authors.forename: Michiel G H
authors.initials: MG
authors.lastname: Betjes
authors.affiliation: Department of Internal Medicine, Erasmus MC, s-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.
authors.forename: Joke I
authors.initials: JI
authors.lastname: Roodnat