Kidney transplantation
Outcome
Comparison of Outcomes of Living and Deceased Donor Kidney Grafts Surviving Longer Than 5 Years in Korea

https://doi.org/10.1016/j.transproceed.2010.02.032Get rights and content

Abstract

Background

It is generally recognized that living donor kidney transplantation (LDKT) grafts are superior to deceased donor kidney transplantation (DDKT) grafts. We compared survival and functional outcomes of LDKT and DDKT grafts.

Methods

Among 1000 kidneys transplanted from 1995 to 2008, we selected grafts surviving >5 years, excluding pediatric, multi-organ transplantation, and retransplantations (n = 454).

Results

There were 179 kidneys from deceased donors and 275 from living donors. Recipients showed no difference in age, gender, or cause of renal failure. Donors were younger in the DDKT group (30.6 vs 38.5 years; P < .05). There were more male donors in the DDKT group (73.2% vs 54.5%; P < .05). Deceased donors showed a greater mean number of HLA mismatches (4.2 vs 2.7; P < .05). Death-censored graft survival at 10 years showed no difference (DDKT 88.9% vs LDKT 88.9%; P = .99). Mean serum creatinine at 5 years was 1.41 mg/dL for DDKT and 1.44 mg/dL for LDKT (P = .75). Mean estimated glomerular filtration rate at 5 years was 67.8 mL/min/1.73 m2 for DDKT and 62.1 mL/min/1.73 m2 for LDKT (P = .23). Twenty-three DDKT grafts (12.8%) and 47 LDKT grafts (17.1%) experienced acute rejection episodes (P = .22). DDKT recipients showed more cases of viral and bacterial infections compared with LDKT recipients (viral, 11.7% vs 2.2% [P < .05]; bacterial, 21.8% vs 7.3% [P < .05]).

Conclusion

Among kidney grafts surviving >5 years, there was no difference in survival or serum creatinine levels at 5 and 10 years between DDKT and LDKT grafts.

Section snippets

Patients

From February 1995 to August 2003, 561 kidney transplantation cases were performed yielding 532 cases after excluding pediatric multi-organ procedures and retransplantations.

Estimated Glomerular Filtration Rate

The most recently advocated formula for calculating the glomerular filtration rate (GFR) is from the Modification of Diet in Renal Disease Study Group.9 The commonly used formula estimates GFR using 4 variables: serum creatinine, age, race, and gender. The equation has been validated in patients with chronic kidney disease.

Results

Among 532 kidney transplantation cases 216 kidneys were from deceased donors and 316 from living donors. Patient characteristics are described in Table 1. Recipients showed no difference in age, gender, or cause of renal failure. Donors were younger in the DDKT group (31.3 vs 38.9 years; P < .05). There were more male donors in the DDKT group compared with the LDKT group (73.4% vs 53.8%; P < .05). Deceased donors showed a greater fraction of HLA mismatches than living donors. Survival analysis

Discussion

In the early days of organ transplantation, the emphasis of clinicians and researchers was on prevention of acute rejection episodes to achieve improved short-term graft survivals. Now that these early goals have been met with effective immunosuppression, attention is slowly turning to long-term issues associated with transplantation.

Recently articles have reported long-term morbidity and mortality of transplantation. Matas et al10 identified a relatively steady rate of graft loss among 10-

References (10)

There are more references available in the full text version of this article.

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    This finding is contrary to some published studies [3,14]. Schwarz et al [14] found that LDKT recipients had a better early (6 weeks after transplant) and late (1 year after transplant) renal function than DDKT recipients, While Lee et al [3] found that among kidney grafts surviving over 5 years, there was no difference in survival or serum creatinine levels at 5 and 10 years between DDKT and LDKT grafts. In this study, the inferior eGFR might be attributed to donor characteristics.

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    In our study, factors such as the gender and the age of the recipients did not seem to affect the graft survival. Other studies have shown that living donor kidney had higher graft survival and lower acute rejection rates compared with deceased donor organs [21–23]. Moreover, this research showed that the transplantation from a living donor contributes to the reduction of the shortage of transplants; it allows a better survival rate and a long-term renal function of the graft.

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