Commercially motivated renal transplantation: results in 540 patients transplanted in India. The Living Non-Related Renal Transplant Study Group.

Commercial renal transplantation is widely condemned on moral and ethical grounds. Moreover, previous studies involving small numbers of patients, mostly from tertiary care centers, have reported poor patient and graft survival. The Living Non-Related Renal Transplant Study Group was established to determine the overall results and complications in a large number of patients who received this type of transplantation in India. In this study we retrospectively collected data from 22 centers on 540 patients who had received commercial renal transplantation (CRT) in India between 1978 and 1993. The data collected included demographic characteristics of patients, the primary renal disease, dialysis and pretransplant data, immunosuppressive regimen, rejection episodes, post-transplant data, as well as patient and graft outcomes. Results were compared with those of 75 recipients of emotionally related renal transplantation (ERT) performed in two participating institutions in the Middle East. Among the 540 patients, 7.5% were younger than 20 yr of age and 14.2% were 50 yr of age or older. After adjusting for several variables, the 1-, 3-, and 5-yr patient survival rates in the CRT were 97, 94, and 92%, and in the ERT 95, 91, and 91% respectively (p = 0.4921). The corresponding rates for graft survival were 90, 81, and 72%, and 90, 86, and 83%, respectively (p = 0.5336). There was a higher incidence of human immune deficiency virus (HIV) infection (4.6% vs. 0% p = 0.053), and hepatitis B virus (HbsAg) infection rate (8.1% vs. 1.4% p = 0.03) in CRT. In conclusion, patient and graft survival rates in recipients of commercial renal transplantation are similar to those in recipients of emotionally related transplantation done in our institutions. However, the incidence of serious infections with HIV and HbsAg is significantly higher.