Background: Spousal renal donation has become an important source of donor kidneys. Recent studies have shown good transplant outcomes in kidneys coming from spouses when compared to other living donors. Herein, we examined and compared our results between spousal donors and living related kidney transplantation. Methods: From 02/03 to 03/13 twenty six (n=26) spouse donor kidney transplants were performed. They were compared with an age/sex matched living related (sibling donors) kidney transplantation group (n=48). Outcomes measured were: 1-year acute rejection incidence, kidney graft function, patient/graft survival. P < 0.05 was statistically significant. Results: 63% patients were male. Mean age was 37.2 ± 9.8 years. Recipient BMI was 26.3 ± 4.2 kg/m2. 59.3% were on PD. Mean time of dialysis was 29.2 ± 20.2 months. 59.3% donor were female, donor BMI was 26.5 ± 2.5 kg/m2. There was no statistical significance between spousal donors and control group in sex, age, BMI, renal failure etiology, dialysis, donor sex and donor BMI. Spousal donors have higher eGFR (MDRD) (125.4 ± 14.3 ml/min) than control group (116.3 ± 15 ml/min) (p=0.01). Basiliximab induction was used in all (100%) spouse donors and 93.8% in control group (p=ns). 1-year acute rejection incidence was higher in spousal donor (14.8%) than group control (4.2%) (p=ns). 1-year and 5-year eGFR by MDRD were similar between groups (1-year: 61.9 ± 25.8 ml/min spouse vs. 67.6 ± 22.9 ml/min siblings) (5-year: 51.7 ± 17.2 spouse vs. 61.8 ± 28.6 ml/min) (p=ns). 10-year patient survival was 90% and control group 95% (p=ns). Uncensored 10-year graft survival was 89% in spouse donors and 79% in control group (p=ns). Conclusion: Excellent and similar results in long-term transplant outcomes are obtained in kidneys coming from spousal donors compared to living related kidney transplants. Spouse should be encouraged as living donors.