The impact of deceased versus living donor graft status on kidney transplant outcomes: A Johannesburg single-center 48 years experience of 1,685 patients

Abstract

Background This study is aimed to determine the impact of living donor (LD) versus deceased donor (DD) kidney transplantation on renal graft survival and patient overall survival rates within Johannesburg, South Africa. Materials and methods A retrospective assessment was conducted of all 1,685 adult first kidney-alone kidney transplant recipients transplanted between the years 1966 and 2013 in a single center. The patients were divided according to the source of the transplant: LD versus DD. Demographics and post-transplantation follow-up data were determined and tabulated. Graft and overall survival plots were generated. Results Of the recipients enrolled, 84.1% were DD recipients and 15.9% were LD recipients. LD recipient status was significantly associated with younger age (p ≤ 0.0001), a higher proportion of white, Asian, or mixed race compared to black race (p ≤ 000.1), a higher proportion of urologic etiology of disease (p = 0.015), and a lower proportion with hypertension (p ≤ 0.0001) as the cause of ESKD. Results showed a decreased risk of graft failure (HR 0.55; 95% CI 0.45–0.66) and a decreased risk of death (HR 0.47; 95% CI 0.36–0.61) among LD graft recipients as compared to DD graft recipients. Conclusions In keeping with internationally reported trends, LD recipients continue to have enhanced patient and graft survival outcomes as compared to DD recipients within our local experience. This Johannesburg experience will serve as a foundation for future related studies in this region of the world.