Living-unrelated Donor Research Articles

The global dilemma of unrelated organ donation

Sirs, We appreciate the comments by Dr. Fine [1] regarding our recent study [2]. The Egyptian experience is essentially driven by the lack of any formal legislation for organ transplantation, and, also for cadaver donor transplants. We hope that this legislation will appear soon, as this will partly help in solving this chronic problem. My opinion is that organized live unrelated donation—the Iranian way—will solve the problem radically. However, in the early 1990s the Egyptian Society of Nephrology voluntarily decided to abandon all unrelateddonor transplantation, a decision which was supported by the Egyptian Medical Syndicate [3]. This was followed by a nearly 20% reduction in the number of transplant operations during the next year [4]. Eventually, the Egyptian Medical Syndicate eased the regulations by accepting unrelated donors for recipients of the same nationality. However, this clearance would not provide legal support of any value. So, most transplant centers, including ours, developed their own ethics committees and obtained additional consents, in order to confer institutional rather than team legal responsibility on live unrelated donor (LURD) transplantation [5]. Unfortunately, a few members of the profession breached the Syndicate’s order by illegally performing transplantations from Egyptian donors to non-Egyptian recipients. In our institution, when there is a medical necessity we can accept patients with unrelated donors. However, we must be sure that each patient’s first-degree relatives are not fit for donation, from the medical and psychiatric points of view. Thereafter, when we are sure that they are medically unfit for donation, we accept LURDs only after a group decision (local ethics committee), as mentioned in the Methods section of our manuscript [2]. All members of the ethics committee meet the donor, so that they can be certain of the donor’s free willingness to donate an organ; moreover, a signed consent form from at least one member of his/her family should be available. At the end of the pre-transplantation assessment, we obtain permission from the ethics committee of the General Medical Syndicate. Location of a suitable donor became the function of tissue-typing laboratories, whose role has gradually shifted from individual pair matching to exchange of donors recruited by different recipients, for the sake of best matching and, finally, to act as “live donors’ banks” [5]. For a few years we have adopted the policy of following up the donors, whether related or unrelated, to identify and potentially treat any adverse consequences of the donation.

Similar Lipid Profile But Improved Long-Term Outcomes With Sirolimus After Cyclosporine Withdrawal Compared to Sirolimus With Continuous Cyclosporine

Renal transplant recipients show an increased risk of cardiovascular disease compared with a nontransplant population. Herein we have shown an analysis of a randomized controlled trial wherein 525 patients receiving a first or second (9.7%) renal allograft from a deceased (89.1%), a living-related (7.8%), or a living-unrelated donor (3.1%) received sirolimus (SRL), cyclosporine (CsA), and steroids (ST) at the time of transplantation with randomization at 3 months after transplantation of 430 eligible patients to continue on SRL-CsA-ST or to have CsA withdrawn with increased SRL trough targets (SRL-ST group). Graft survival, patient survival, and renal function at 5 years were analyzed by average fasting total cholesterol (<or=200 or >200 mg/dL) and triglyceride (<or=240 or >240 mg/dL) subgroups. At 5 years, total, high-density lipoprotein (HDL), and low-density lipoprotein [LDL] cholesterol and triglyceride values were similar between the groups. Statins ( approximately 80% of patients of both groups) were most effective to lower cholesterol ( approximately 50 mg/dL; P < .001; both groups), and fibrates ( approximately 25% of patients of both groups) were most effective to decrease triglycerides ( approximately 100 mg/dL; P < .001; both groups). Renal function and blood pressure were significantly better with SRL-ST. Hypercholesterolemia and hypertriglyceridemia were associated with reduced graft survival, patient survival, and calculated GFR, but the only significant difference was lower graft survival among SRL-CsA-ST patients with hypertriglyceridemia. Cardiovascular-related deaths were reported in 3.7% and 2.8% of patients in the SRL-CsA-ST and SRL-ST groups, respectively. In conclusion, when compared with continuous SRL-CsA-ST, CsA withdrawal at 3 months followed by SRL-ST significantly improved glomerular filtration rate (GFR) and blood pressure without a further increase in lipid parameters or an incidence of untoward effects from hyperlipidemia, despite a 2-fold higher SRL exposure.

Live unrelated donor renal transplantation in children—criteria of acceptability

Live unrelated donor renal transplantation in children—criteria of acceptability

Renal Allograft Outcomes From Spousal and Other Living‐Unrelated Donors

AbstractOBJECTIVEThe objective of this study was to compare renal allograft outcomes from spousal donors with those from other living‐unrelated donors (LUD), and to make the best use of spousal donors.METHODSFrom February 1995 to February 2006, 812 renal transplantations were performed at our center, of which 185 were from LUDs. A retrospective analysis was made of all recipients who successfully underwent living‐unrelated renal transplantation.RESULTSA total of 55 out of the 185 recipients received a kidney from their spouses. Compared with other LUDs, spousal donors were older and had poorer human leukocyte antigen (HLA) mismatching. The time from initiation of dialysis to transplantation was shorter in transplantation from spousal donors. The incidence of acute rejection within the first year after transplantation was more frequent in spousal grafts. However 1‐year and 5‐year survival rates for spousal and other living‐unrelated grafts were not significantly different (96.3% and 93.7% for spousal grafts versus 97.7% and 89.3% for other living‐unrelated grafts, p = .925). The survival rate for 5‐year patients was 96.4% and 97.5%, respectively.DISCUSSIONTransplantation from spousal donors has comparable outcomes to those of other LUDs, and shortens time spent on the waiting list. Therefore, spousal donation should be considered as a useful source to overcome an organ shortage.

Influence of HLA disparity, immunosuppressive regimen used, and type of kidney allograft on production of anti-HLA class-I antibodies after transplant and occurrence of rejection

We studied the effects of HLA disparity, immunosuppressive regimen used, and the type of kidney allograft on production of anti-HLA antibodies after transplant and the occurrence of rejection episodes.Five living-unrelated donors and 4 living-related donors kidney recipients received quadruple therapy (including sirolimus and mycophenolate mofetil). Fifteen living-unrelated donors and 19 living-related donors received triple therapy (excluding sirolimus). A single bolus of 4 to 6 mg/kg rabbit anti-human T-lymphocyte immune serum was included with both regimens. Recipients were studied over a 3-year period. Human leukocyte antigen profiles were determined by DNA (SSP) typing, and anti-HLA class-I antibodies were determined by the complement-dependent microcytotoxicity assay and an enzyme-linked immunosorbent assay.The degree of HLA disparity did not appear to affect anti-HLA antibody production or the occurrences of rejection episodes. None of the patients who received quadruple therapy developed anti-HLA class-I antibodies. Two living-unrelated donors and 2 living-related donors recipients who received triple therapy developed anti-HLA class-I antibodies. One of the 2 living-unrelated donors antibody-positive patients rejected the kidney and returned to dialysis, and the other patient has normal graft function 3 years after the transplant. The 2 living-related donors patients with normal graft function were antibody-positive 1 year after the transplant but were antibody-negative at 2 and 3 years after transplant.Sirolimus appeared to inhibit production of antibodies after transplant. Moreover, use of present day immunosuppressive agents diminishes the role of HLA matching in relation to the occurrence of rejection episodes.

Trends in unrelated-donor kidney transplantation in the developing world

Living unrelated donors (LUDs) constitute an incremental source of kidneys for transplantation at a global level. Excellent outcomes are reported, superior to those of deceased-donor transplantation and comparable to related donor transplantation. LUD include six categories: spouses, distant relatives, paired-exchange, living-deceased exchange, and non-directed and directed donors. Although a financial reward may be involved in any of these categories, it is in the declared selling of organs that ethical concerns have intensified. There are three patterns of paid LUDs in the developing world: organized, erratic and commercial. The only model of organized LUDs is in Iran, where a central agency assigns and compensates the donors. Erratic LUD transplantation has been experienced, and subsequently banned, in the development of transplant programmes in most developing countries. However, the tightness and enforcement of the official ban are geographically different, providing variable room for uncontrolled trafficking. Commercial transplantation has, thus, become phenomenal in a few countries, gradually evolving into an organized business that follows market dynamics, including advertisement, brokerage, commissions, auctions and tourism. While most international organizations and activist groups condemn commercial transplantation, it is often perceived, in certain cultures and under particular socioeconomic standards, as a human right that meets the demands of all stakeholders, and should be organized rather than declined just for the purpose of meeting the values of a third party.

Study of the effect of donor source on graft and patient survival in pediatric renal transplant recipients

Evaluation of the impact of live unrelated kidney donor (LURD) source on the outcome of renal transplantation is not adequately studied. We aimed to compare the long-term outcome of kidney transplantation from LURDs to that from living related donors (LRDs) among a pediatric recipient population. This study comprised 235 pediatric recipients who received their kidney grafts between 1976 and 2005 at our center. These patients were further subdivided into two groups according to donor source (211 with LRDs) and (24 with LURDs). All patients' data were assessed with special emphasis on graft and patient survival as well as posttransplant medical complications. Both groups were comparable regarding graft and patient survival at 1, 5, and 10 years. Despite higher incidence of acute vascular rejection among recipients with LURD (12%) vs. LRD (2.8%) (P = 0.03), there was no difference in the incidence of chronic allograft nephropathy. Moreover, the overall incidence of posttransplant complications was comparable among the two groups. In our series, kidney survival was poorer in LURDs compared with LRDs. However, the number of patients with LURD was small, and the difference in results was also small and justifies LURD in exceptional cases when LRD is not possible.

Assessment of the knowledge of living unrelated donors of the complications of kidney donation in Iran

Living unrelated donors (LURDs) constitute the major source of renal allograft in Iran. LURD transplantation (Tx) is performed in a controlled program, supervised by university Tx teams, and assisted by the Dialysis and Transplant Patient's Association (DATPA). This study evaluated the knowledge of donors about possible short- and long-term complications of kidney donation and the need for regular follow-up. We interviewed 100 consecutive living donors/donation candidates (all called donors), 35 in the postoperative period in the renal Tx ward, and 65 after completion of preoperative assessment in the office of the DATPA, to assess their knowledge about complications of nephrectomy and their intention to participate in the postoperative follow-up. Seventy-nine donors were men and 21 women. Mean age was 27 +/- 4.4 years. Ninety-seven donors were unrelated to the recipient and three were related (LRD). The motivation for donation was altruistic in nine (three LRD and six LURD) and financial in 89. Eighty donors were not aware of the possible short- or long-term complications of nephrectomy. Six donors mentioned the possibility of potential intraoperative complications, and 16 mentioned the risk of renal failure. Only 44 donors knew that they should visit doctors regularly after donation, most of them (61%) from the postoperative group. We conclude that most donors do not have enough knowledge about possible in-hospital and long-term complications of kidney donation and may not participate in regular follow-up after operation. Considering the young age of our renal Tx donors, we suggest that they should receive more preoperative orientation (both verbal and written) about possible complications and the need for regular postoperative medical follow-up.

A National Program for Nondirected Kidney Donation From Living Unrelated Donors: The Philippine Experience

Objectives The objectives of this study are to describe the mechanism of the program and to present initial donor outcome. Methods This is a descriptive study evaluating the performance of a national program for nondirected kidney donation from living unrelated donors (LURDs) in the Philippines in its 3-year implementation. It explains the mechanism of the program and socioeconomic and clinical profiling of donors. Frequencies and percentages were used to measure donor demographic data, medical follow-up compliance rate, and employment predonation and postdonation. Diagnostic laboratory criteria were required to show donor clinical profiles. Results In 2002, the local Health Department issued an administrative order to create a National Transplant Ethics Committee (NTEC) to address issues of rampant organ sale and donor exploitation. It also set guidelines and intended to oversee transplantation from LURDs. Salient points to the program are as follows: (1) prohibition of sale; (2) accreditation of transplantation centers; (3) enrollment of waitlisted patients in both deceased donor and nondirected LURD program; (4) ethics committee evaluation of LURDs; (5) creation of a national kidney transplant wait list and live donor registry allowing centralized, nondirected kidney allocation; (6) 10% cap on allocation to foreigners; (7) creation of a kidney donor monitoring unit with free 10-year annual medical follow-up for feedback evaluation on donor outcome; and (8) allowance of gratitudinal gifts such as health and life insurance, reimbursement for lost income, educational plan, and job placement to LURDs run by a foundation. From 2004 to 2006, 695 potential donors enrolled; 97 were accepted and deemed medically fit to donate. The remaining 598 were rejected due to demand for outright sale (103), medical unsuitability (77), disapproval by the Ethics Committee (12), and retracted consent (406). Of the 97 qualified donors, 79 had donated, 9 were being evaluated, and 9 await allocation at the end of 2006. Donor demographics show the following: 54% (381) single, 77% (538) males, and 70% (488) aged 21–40 years old. Sixty-eight of 79 became small-scale entrepreneurs postdonation. Also, 53% (42 of 79) complied with medical follow-up requirements. Mean serum creatinine level at 6 months, 1 years, and 2 years were 1.3, 1.33, and 1.05 mg/dL, respectively. Two donors had trace protein and 1 had (+1) protein. Discussion and Conclusions The majority of the donors are single males, aged 21–40 years with blue collar jobs. Major reasons for dropouts are retracted consent and medical unsuitability. Donors have improved socioeconomic status. In this study, 53% complied with expected medical follow-up, showing mean serum creatinine within normal range. Proteinuria appeared in 2 of 79 donors. This regulated approach provides a rational, accessible, and equitable donor allocation program. It safeguards the rights of donors and avoids donor exploitation and proliferation of unregulated organ sale. Data collection on their postoperative renal function will show long-term outcome of kidney donation from live donors.

Exchange Living-Donor Kidney Transplantation: Merits and Limitations

The shortage of donor organs is one of the major barriers to transplantation worldwide. After the success of the direct exchange donor (swap) program in Korea since 1991, we have developed a swap-around program. However, reports on the long-term outcomes of exchange donor programs are scarce. From September 1995 to September 2006, we performed 1193 cases of renal transplantation, including 398 cases from living-unrelated donors. The living-unrelated donors included 129 exchange donors and 269 nonexchange donors. We compared the outcomes of the exchange program with that of the nonexchange program, and examined the merits and limitations of the exchange program. The reasons for the exchange program were ABO incompatibility (n=84, 65.1%), human leukocyte antigen mismatching beyond our criteria (n=39, 30.2%), or positive lymphocyte crossmatch (n=6, 4.7%). The overall 10-year graft survival (86.3%) of exchange transplantation was comparable with that of nonexchange (82.3%) or one- haplotype matched living-related (81.2%) transplantation (P=0.2994). In multivariate analysis, exchange versus nonexchange donors did not affect graft survival. The proportion of blood-type O donors was much lower in the exchange group (29.5%) than in the nonexchange group (42.4%; P=0.026). Blood-type O kidneys were preferentially allocated to blood-type O recipients (78.9%) in the exchange group as compared with the nonexchange group (54.4%; P=0.007). We achieved excellent outcomes by using a donor exchange program as an option to reduce the donor organ shortage. However, the exchange donor program has no added benefit for blood-type O recipients.

ABO Incompatible Renal Transplantation in an HIV-Seropositive Patient

To date, there have been no reports of successful ABO blood group incompatible renal transplantation in HIV patients. We describe a case of a 47-year-old African American man with end-stage renal disease secondary to HIV-induced nephropathy who underwent a live unrelated (spouse) donor ABO blood group incompatible transplant using an intravenous immunoglobulin/plasmapheresis preconditioning regimen with interleukin-2 receptor antagonist induction along with tacrolimus and mycophenolate mofetil maintenance. The postoperative course was complicated by two acute cellular rejection (Banff Ia) episodes that were successfully managed with corticosteroid boluses and the addition of corticosteroids to maintenance immunosuppression. Antibody-mediated rejection was not observed on biopsy. The patient reached a serum creatinine nadir of 2.0 mg/dL on postoperative day 20, which has now been maintained for 170 days. His current CD4 count was 410 cells/microL.

Parental Donors in Live-Donor Kidney Transplantation Associated With Increased Rejection Rates and Reduced Glomerular Filtration Rates

Living unrelated and related kidney transplantation has been shown to have similar allograft survival. However, the effect of donor-recipient relatedness in living-related and unrelated kidney transplantation on graft and patient survival remains uncertain. Using Australia and New Zealand Dialysis and Transplant Registry, primary living renal transplant recipients in Australia between 1995 and 2004 were studied (n=1989). Donors were categorized according to their relationship with recipients: parent (n=606), child (n=103), spouse (n=358), sibling (n=656), other living-related donors (n=81), and other living-unrelated donors (n=185). Outcomes analyzed included the presence of rejection at 6 months, estimated glomerular filtration rate (eGFR) at 1 and 3 years, graft survival, and patient survival. A greater proportion of renal transplant recipients from parental and spousal donors were transplanted preemptively. Donor groups had no relationship with graft or patient survival. Parental donors were associated with an increased relative odds of acute rejection (odds ratio 1.69, 95% confidence interval 1.13-2.53, P=0.009) and a lower eGFR at both 1 and 3 years (coefficient -2.99 and -5.68, respectively; P<0.0001) compared to other donor groups (reference sibling donor group). This study has established that donor-recipient relatedness in both related and unrelated living kidney transplantation had no significant effect on graft and patient survival. Parental donors were associated with a higher relative risk of rejection and lower eGFR in the transplant recipients, although these findings did not translate to a worse graft outcome.

Association between recipient ICAM‐1 K469 allele and renal allograft acute rejection

SummaryIntercellular adhesion molecule 1 (ICAM‐1) genetic polymorphisms (G241R and K469E) have been implicated in several autoimmune and inflammatory conditions. Investigating a sample of living‐unrelated donor (LURD) kidney transplant pairs, we revealed an association between recipient K469 allele (P = 0.013) and K/K genotype (P = 0.042) with renal allograft acute rejection.

Socioeconomic Status of Iranian Living Unrelated Kidney Donors: A Multicenter Study

Renal transplantation is the best treatment modality for end-stage renal disease (ESRD) patients. In Iran, a living unrelated donor (LURD) transplant program was started in 1988, because of the shortage of living related and cadaver donors. In this study, we evaluated the socioeconomic status of LURD in Iran. We enrolled 478 LURDs from 30 transplant centers between October 2005 and March 2006. The demographic data, education, employment, motivation, and satisfaction status were asked. Economic status was assessed using criteria of the statistics center of Iran. Ninety-six percent of donors were referred from the Kidney Foundation of Iran (KFI). The mean age of the donors was 27 ± 4.8 years and 85% were men ( n = 408). Fifty-one percent were smokers, 82% married, and 79% the breadwinner; 29% were unemployed; 2.7%, 90.8%, and 6.5% were illiterate, school graduates, and university graduates, respectively. Coercion was documented for only one donor. Financial issues were the most frequent motive. Among them, 91% were satisfied with the donation. Finally, 53% suggested kidney donation to others. Of donors, 62% were living below the poverty line. In the Iran model, the KFI is a bridge that connects recipients and donors. As a result, there is no middle man or broker introducing donors to recipients. The transplantation team knows nothing about money transactions between recipient and donor. Most donors were satisfied with the donation. However, establishment of a government-regulated program for social support of donors, such as lifelong health insurance may be a compensation for donors.

Renal Transplantation in Iran Over the Past Two Decades: A Trend Analysis

Background In this study, we have reported updated statistics of the Iranian Transplantation Registry, the status of the recipients and grafts, and a detailed time trend with respect to patient characteristics. Methods We retrospectively reviewed the Iranian Renal Transplantation Registry and information from the Dialysis and Transplant Patients Public Association, to obtain data on all kidney transplantations performed in Iran between 1986 and 2005. Data were gathered regarding the total number of transplantations, graft loss, recipient death, and donor and recipient characteristics, including demographic data, cause of end-stage renal disease (ESRD), and source of kidney. We assessed changes in variables on a biannual basis. Results A total of 19521 transplantations were registered over the study period, of which, 761 recipients (3.9%) had died and 2333 allografts (11.9%) had been lost. The source of the kidney in 2556 (13%) subjects was a living related donor (LRD), in 16234 (83%) a living unrelated donor (LURD), and in 831 (4%) cadaveric. During the study decades we noted an increase in the number of kidney transplantations (from 22 to 3690), age of recipients (from 30 to 40), male-to-female ratio of recipients (from 0.58 to 0.67), male-to-female ratio of donors (from 0.48 to 0.52), diabetes mellitus (from 0% to 27%), and hypertension (from 4% to 15%), as causes of ESRD, as well as the use of cadaveric kidneys (0% to 11%). Conclusion Analyzing renal transplantation data not only helps to evaluate the effectiveness of transplantation activities in a country, but also provides information to estimate future costs in the health care system.

The Incidence and Risk Factors of Delayed Graft Function in 689 Consecutive Living Unrelated Donor Renal Transplantation

Due to the severe shortage of deceased donor kidneys, the number of renal transplantation from living-related and living-unrelated donors has increased worldwide. The incidence and risk factors of delayed graft function after deceased donor renal transplantation have been extensively studied. In this analysis, the incidence and predictors of delayed graft function was investigated in 689 living-unrelated kidney recipients. In 53 recipients, dialysis was needed within the first week after renal transplantation (7.7%). The risk factors for delayed graft function upon univariate analysis models were: female gender of kidney donor ( P = .027), renal allograft with multiple arteries ( P = .005) and previous transplantation ( P < .005). Upon multivariate analysis, the only risk factor for development of delayed graft function was retransplantation ( P = .001).

Education is key to controlling visceral leishmaniasis

Education is key to controlling visceral leishmaniasis

The Predictive Value of HLA-DR Matching and Cytokine Gene Polymorphisms in Renal Allograft Acute Rejection: a Living-unrelated Donor (LURD) Study.

In addition to Human Leukocyte Antigens (HLA) compatibility, gene polymorphism in cytokines might be important in the quality of allogeneic immune response. In this study HLA-DR matching and a number of cytokine gene polymorphisms have been evaluated in occurrence of acute rejection after living-unrelated donor (LURD) kidney transplantation. A total of 42 renal transplants that were performed at Hashemi Nejad Kidney Hospital (Tehran/Iran) and then followed up for 3 months post-transplantation were included in our study. Using PCR-SSP, HLA-DR alleles (DR1-18) of recipient and donor pairs and gene polymorphisms in TNF-, TGF-1, IL-10, IL-6, and IFN- of recipients were determined. Acute rejection was observed in 11(26.2%) of 42 renal recipients. The frequency of one and two HLA-DR mismatches in rejector and nonrejector groups were 2(18.2%), 9(81.8%) and 13(41.9%), 17(54.8%) respectively. HLA-DR incompatibility was not significantly higher in rejector (1.820.40) than nonrejector (1.520.57) recipients (P=0.069) and more than half of nonrejectors had completely mismatched HLA-DR antigens with their donors. Polymorphisms associated with all the cytokines mentioned above were found to have no correlation with acute rejection. Regarding to high frequency of HLA-DR mismatching in nonrejector group, we can postulate that the immunogenecity of LURD renal transplant is not similar to the cadaveric one, and predictive value of HLA-DR mismatching for acute rejection is not as reliable as in cadaveric transplant. Although, there is no doubt about influence of HLA compatibility on allograft survival. In addition, we failed to demonstrate further association between combined recipient cytokine genotypes and HLA-DR matching with acute rejection in this study. Thus, we conclude that a more detailed immunogenetic profile is necessary to predict transplant outcome or immunosuppression tailoring.

Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation

Since the 1980s, many countries have passed legislation prohibiting monetary compensation for organ donation. Organ donation for transplantation has become altruistic worldwide. During the past two decades, advances in immunosuppressive therapy has led to greater success in transplantation and to increased numbers of patients on transplant waiting lists. Unfortunately, the altruistic supply of organs has been less than adequate, and severe organ shortage has resulted in many patient deaths. A number of transplant experts have been convinced that providing financial incentives to organ sources as an alternative to altruistic organ donation needs careful reconsideration. In 1988, a compensated and regulated living-unrelated donor renal transplant program was adopted in Iran. As a result, the number of renal transplants performed substantially increased such that in 1999, the renal transplant waiting list was completely eliminated. By the end of 2005, a total of 19,609 renal transplants were performed (3421 from living related, 15,356 from living-unrelated and 823 from deceased donors). In this program, many ethical problems that are associated with paid kidney donation also were prevented. Currently, Iran has no renal transplant waiting lists, and >50% of patients with ESRD in the country are living with a functioning graft. In developed countries, the severe shortage of transplantable kidneys has forced the transplant community to adopt new strategies to expand the kidney donor pool. However, compared with the Iranian model, none of these approaches has the potential to eliminate or even alleviate steadily worsening renal transplant waiting lists.

Living Unrelated Versus Living Related Kidney Transplantation: 20 Years’ Experience With 2155 Cases

Purpose To compare the long-term results of kidney transplantation from living unrelated donors (LURDs) with that from living related donors (LRDs). Materials and methods From 1984 to 2004, we performed 2155 kidney transplantations of which 374 were from LRDs and 1760 from LURDs. We reviewed and compared the long-term data from these cases. Results The LURD group included 64.2% men with an overall mean age of 33.46 ± 14.61 (range 3 to 76) years. Laparoscopic donor nephrectomy was performed in 329 cases (18.7%) with mean follow-up of 45.68 ± 46.80 months. The LRD group included 66.5% of male recipients with overall mean age of 28.97 ± 9.58 (range 9 to 65) years. Laparoscopic donor nephrectomy was performed in 12 cases (3.2%) of LRDs with mean follow-up of 81.15 ± 67.03 months. One-, 3-, 5-, 10-, and 15-year graft survivals among LRDs were 91.6%, 81.7%, 76.4%, 64.4%, and 48.4%; and for LURDs, 91.5%, 86.7%, 81.4%, 68.2%, and 53.2%, respectively ( P = .07). Patient survivals for 1, 3, 5, 10, and 15 years in LRDs were 94.6%, 91.9%, 83%, 79.5%, and 73.9%, and in LURDs were 93.6%, 91.7%, 89.3%, 84%, and 76.4%, respectively ( P = .14). Conclusion The results of living unrelated kidney transplantation upon long-term follow-up with a large number of cases were as good as living related kidney transplantation. The organ shortage can be alleviated by using living unrelated kidney transplantation. To our knowledge this is the largest experience with long-term follow-up reported from one center to date.