Kidney transplants from distant relatives

Abstract

From January 1, 1968 to June 1976 twenty patients received first kidney transplants from distant relatives including half-siblings, uncles, aunts, cousins, nephews, or grandparents. All recipients have been followed for at least one year and several for as long as nine years. Only one patient has been lost to follow-up six years post transplantation. The absolute one year patient survival is 85 per cent and the five year actuarial survival is 78.5 per cent including all causes of death, even death on dialysis years after kidney loss. The absolute one year functional survival is 75 per cent and the five year actuarial kidney survival is 51 per cent. Only three patients had diabetes in this series; one died after rejection and two survive and are well with kidneys at twenty-four months. There was no relationship of type of relative or number of shared HLA antigens with function and survival in this small series. The results are essentially equal to the results of transplants to siblings differing at one HLA haplotype, and well matched (2 to 4 HLA shared antigens) cadaver transplants except for a late high incidence of chronic rejection in recipients of distantly related transplants. If no closer blood-related volunteer is available, a more distant relative can be used with greater success than a poorly matched cadaver. On the other hand, if a large number of cadaver kidneys are available, a well matched cadaver kidney is worth waiting for and is equally successful as kidneys from distant relatives.