Living donor transplants.

The number of living donor transplants reported to the UNOS Scientific Renal Transplant Registry has increased from 1,810 in 1988 to 2,861 in 1994. Nearly all 250 United States transplant centers have reported living donor transplants. Graft survival rates were uniformly high for recipients of living donor transplants. One- and 5-year survival ranged from 95% and 84% for 3,653 HLA-identical sibling transplants to 89% and 69% for 1,981 offspring-to-parent transplants. Transplant half-lives ranged from 10 years for 360 transplants from nonspouse unrelated donors to 22 years for 3,653 transplants between HLA-identical siblings. These half-lives were significantly better than the 9 year half-lives projected for cadaveric grafts (p<0.01). The 282 second transplants from HLA-identical sibling donors had one- and 5-year survival rates of 94% and 80%, respectively, which were not significantly different than those of first grafts. The 1,005 retransplants from HLA-mismatched living donors had one- and 5-year survival rates of 88% and 69%, respectively, 2% below the survival rate for first transplants (p=0.026). The one- and 5-year graft survival rates for 1,932 zero-HLA haplotype matched living donor transplants were 89% and 73%, respectively, and the half life was 13.6 years. These results were comparable to those for parent donor transplants. Although the graft survival rates were similar regardless of the donor's relationship to the recipient, the causes of graft failure differed. About 48% of graft failures among parents who received a kidney from their offspring were deaths with a functioning graft. Only 12% of failures among parent-to-offspring transplants were deaths. One- and 5-year graft survival rates were 85% and 57%, respectively, for Black recipients of parent donor kidneys, and were 95% and 68%, respectively, for Blacks with an HLA-identical sibling donor transplant. The results were higher for comparable Whites: 91% and 73% for parental, and 95% and 86% for HLA-identical sibling grafts, respectively. HLA-mismatched transplants to 656 broadly sensitized recipients resulted in 83% and 62% one- and 5-year graft survival rates, respectively. The comparable results for those with less than 50% PRA were 91% and 73% (p<0.001). Pretransplant blood transfusions did not result in improved graft survival, nor in a reduced incidence of early rejection episodes. Information was not available to distinguish between donor-specific and random donor transfusions. The oldest living donor was aged 76, and 404 donors were over age 60. The one- and 5-year survival rates were 86% and 61%, respectively, for donors over age 60. The comparable results for younger donors were 90% and 72% (p=0.005).