Spousal Donors Research Articles

The Older Living Kidney Donor: Part of the Solution to the Organ Shortage

Strategies to increase kidney transplantation are urgently needed. We studied all (n = 73,073) first kidney-only transplant recipients in the United States between 1995 and 2003 to determine the incidence and outcomes of living donor transplantation as a function of donor age. Because 90% of living donors were <55 years, we defined older living donors as > or =55 years. Factors associated with transplantation from older living donors and the association of living donor age with allograft function and survival were determined. Recipients of older age, female gender, white race, and preemptive transplants had higher odds of older living donor transplantation. Older living donor transplantation was more likely from spousal donors rather than blood relatives, and more likely when a husband was the donor. The glomerular filtration rate (GFR) one year after transplantation decreased with increasing donor age (P < 0.001). Graft survival from living donors > or =55 years was 85% and 76% at three and five years (compared to 89% and 82% with living donors <55 years, and 82% and 73% with deceased donors <55 years). In a multivariate model, the risk of graft loss with living donors 55-64 years was similar to that with deceased donors <55 years, while recipients from living donors 65-69 years (HR = 1.3, 95% CI: 1.1-1.7) and >70 years (HR = 1.7, 95% CI: 1.1-2.6) had a higher relative risk of graft loss. Outcomes are excellent with living donors <65 years. Expanded use of older living donors may help meet the demand for transplantation.

Comparison of Spousal With Other Donor Groups: Study of a Single Center

In coping with the shortage of living-related and cadaveric donor groups for renal transplantation, and in the fear of organ marketing, spousal donors are considered an invaluable potential source. Survival rates have been reported to be as high as even some related groups. This study evaluated 1039 renal transplantations up to 2003. Patient survival rates in different donor groups were determined using the Kaplan-Meier method. The 3-year patient survival rates were 93% for kidneys from 61 spouses; 92% for kidneys from 433 living-related donors; 91% for kidneys from 427 living-unrelated (excluding spouses) donors; and 90.5% for 118 cadaveric kidneys. Such results were consistent with many other reports which consistently showed that spousal donors were at least as good as living-related donors, representing a reliable source in cases of organ shortage. The high survival rate of spousal donors is probably related to their strong emotional support.

Lack of Impact of Human Leukocyte Antigen Matching in Living Donor Kidney Transplantation: Experience at Akdeniz University

Lack of expansion of the deceased donor supply has resulted in a severe shortage of organs worldwide. Spousal donors are one possible alternative organ source for patients on the kidney transplant waiting list. Despite human lymphocyte antigen (HLA) matching between recipients and unrelated donors being poor, the reported survival rates for these grafts, including spouses, are comparable to those for grafts from living related donors and higher than those for deceased donor kidneys. In 2000, our renal transplantation program began accepting living donor–recipient pairs with one or zero HLA matches. The purpose of this study was to assess this policy for accepting living unrelated donors. The 3-year graft survival rates for the transplants from living unrelated donors were similar to that for transplants from living related donors (log-rank = 0.078). The number of HLA mismatches did not significantly influence the survival rates for either of these groups of living donor transplants. Multivariate analysis revealed that dialysis duration ( P = .057) and recipient age ( P = .066) negatively influenced patient survival in living donor kidney transplantation. The graft and patient survival rates for the donor transplantations were higher than those for deceased donor transplantations. In light of these findings and considering the increasing problem of organ shortage, we conclude that living unrelated kidney transplantation should be performed, with strict guidelines. Spousal donation is the most favorable form of living unrelated renal transplantation.

Patterns of Volunteerism, Testing, and Exclusion Among Potential Living Kidney Donors

We found that in kidney transplantation, more females donate. We analyzed transplant recipients for patterns of potential donor exclusion and found that equal proportions of male and female po tential donors existed among first-degree biological relatives. More male recipients were married and therefore had more spousal potential donors. Among friends and non-first-degree relatives, significantly fewer males offered to donate to females. Equal proportions of female and male potential donors were excluded from donating for medical comorbidities, blood type incompatibility, recipient refusal, and potential donor reluctance. We concluded that female transplant candidates had fewer potential donors among spouses and opposite sex volunteers from friends and non-first-degree relatives.

Decision-Related Factors and Attitudes Toward Donation in Living Related Liver Transplantation: Ten-Year Experience

Introduction Living related liver transplantation (LRLT) has been performed since 1994 in Korea; more than 600 donors have contributed to our successful LRLT program for 10 years. Although the decision to donate is difficult and the donors need a formal psychosocial assessment, no system has been available to us for the assessment. This survey was performed as a presurveillance for the development of a psychosocial assessment protocol. Methods A survey questionnaire included 31 questions on general and medical characteristics, factors, and processes related to the decision for donation. Donors of partial livers at least 6 months ago during the period from December 1994 to August 2003 and whose address could be confirmed by telephone were enrolled in the study. Results A questionnaire was sent by mail to 441 contactable donors of whom 209 (47.4%) responded. Male-to-female ratio was 2:1 and mean age was 32.8 years (range: 16 to 60 years). The number of spousal donors was 120 (57.4%) and 164 (78.5%) donors were employed at the time of donation. Protestants, Buddhists, and Catholics were 29.2%, 19.1%, and 14.8%, respectively. Parents were the most common recipients (33.0%), followed by siblings (17.2%), extended family members (17.2%), and children (15.8%); one hundred eighty nine (90.4%) donors had decided by themselves, the major reason for donation in 192 (91.9%) donors was “to save the lives of family members and relatives.” The first person who suggested donation was the donor (64.1%), followed by family members (23.9%) or the attending physicians (8.6%). Although 70.8% of donors answered that they were not hesitant to donate at the time of decision, 44.5% were uneasy at the possibility of being unable to sustain a normal life after donation, at their lack of knowledge on organ donation, and about the pain and fear of surgery. Family members and relatives (53.3%), medical personnel (46.7%), and previous donors (35.4%) were the preferable counselors compared to transplantation institutions and clergymen. The large majority (80.8%) of donors would encourage others to donate. Conclusions Although the decision to donate was made by the donors themselves in most cases and they appeared firm and determined about their decision, a significant number of donors felt uneasy about possible complications of organ donation and effects on their lives after donation. A precise and formal psychosocial assessment protocol is needed to support and secure their decision before and after donation.

Living kidney transplantation: a starting experience

IntroductionWe present our initial experience with living kidney transplantation. Patients and methodsFrom January 2001 to December 2002, we performed 27 living kidney transplants using immunosuppression with induction basiliximab, cyclosporine (n = 10 patients), or tacrolimus (n = 17), mycophenolate mofetil, and steroids. ResultsNineteen (70.3%) donors were women and 8 (29.7%) were men of mean age 50.6 years. Four donors were over 65 years of age at the time of living donation. Donor morbidity was 5.5%: namely, one wound infection and one asymptomatic acute pancreatitis. There were no differences between the preoperative and the postoperative mean serum creatinines and systolic blood pressure values. All living donors are in good health with a mean serum creatinine of 0.80 mg/dL at a mean follow-up of 15.2 months. Nineteen (70.3%) recipients were men and 8 (29.7%) were women of mean age 36 years. Acute rejection occurred in 6 (22.2%) recipients. It was more common among spousal donors and among cyclosporine-treated recipients. Patient and graft survivals at a mean follow-up of 15.2 months was 100%. ConclusionsOur early results showed that accurate selection and preoperative management of potential living donors lead to excellent results in kidney transplantation. The health of the living donors was not impaired by the donation. The rate of early postoperative complications was low. Living donor kidney transplantation, in our geographical area with a low-rate of cadaveric donor transplants, is an alternative to expand the donor pool, which offers better results in term of patient and graft survival.

Kidney transplantation from spousal donors

Kidney transplantation from spousal donors

Expanding the kidney donor pool: Ethical and medical considerations

year later, proteinuria developed. She had an uncomplicated pregnancy in 1990. Five years later, arterial hypertension required treatment with enalapril. Her serum creatinine then was 1.2 mg/dL. The serum creatinine rose to 1.3 mg/dL two years ago and to 1.5 mg/dL last year. Earlier this year, a 24-hour urine collection contained 810 mg protein; the serum creatinine was 1.6 mg/dL and the creatinine clearance was 31 mL/min/ 1.73 m 2 . Her urine sediment was benign. A further increase in her blood pressure necessitated treatment with lisinopril, 10 mg each morning, and amlodipine, 5 mg each night. She says that she has no regrets about her decision to donate despite the outcome. Five years ago, her husband’s brother developed renal failure; with her encouragement, her husband donated a kidney. Her husband, now age 44, is in good health and has normal blood pressure, normal serum creatinine, and no proteinuria.

Gender disparity in living renal transplant donation

Numerous studies document that women constitute the majority of living kidney donors, but the reasons behind the disparity in donation rates between men and women remain obscure. We studied this issue by gathering data on family members of living donor allograft recipients at a single large center over a 5-year period (n = 144). By considering all potential donors (spouses and first-degree relatives) within each recipient’s immediate family, we determined that men and women are excluded as donors at approximately similar rates on the basis of medical condition or known blood group type A, type B, type O incompatibility, and that a greater percentage of acceptable female donors (28.3%) compared with men (20.3%) go on to donate a kidney (P = 0.027). However, when only first-degree relatives are considered, the difference in donation rate between men and women becomes nonsignificant (26.9% of women versus 22.2% of men; P = 0.229). Among spouses, the gender disparity in donation rate is greater (36% of wives versus 6.5% of husbands who are acceptable donors go on to donate a kidney; P = 0.003). Evidence that economic factors may contribute to the overall gender disparity is also presented. In conclusion, the gender disparity among living kidney donors observed in our population can be largely attributed to an overwhelming predominance of wives among spousal donors. Possible explanations and potential interventions to address underrepresentation of male donors are discussed.

Evolution of attitudes at U.S. transplant centers toward kidney donation by friends and altruistic strangers.

A severe shortage of organs is one of the major barriers facing transplantation today. One of the proposals designed to overcome this serious problem is to increase the use of genetically unrelated living kidney donors. Excellent results have been achieved with these volunteers and cogent arguments have been made that this practice is ethically acceptable. These considerations have encouraged many transplant centers to break with tradition and accept spousal donors. To see if there has been a similar change in attitudes toward other types of unrelated living donors, a survey was mailed to 208 U.S. renal transplant centers; 129 (62%) were returned. Ninety-three percent of responding centers said they would accept a close friend as a kidney donor. Although the majority of centers would not consider an altruistic stranger, a sizeable minority (38%) would. When compared with the results of previous surveys, these data show that attitudes toward unrelated living kidney donors have gradually become much more liberal.

Spousal renal transplantation—single-center experience

EVIDENCE of high rates of survival of renal transplants from spousal donors has been reported from different centers, in spite of poor HLA matching. Kidney donation by spouses has been ethically approved in many countries, but is prohibited by law in others. In Iran kidney transplantation (Tx) from spousal donors has been a part of living-unrelated kidney Tx programs. The objectives of this study were to evaluate the patient and graft survival rates in spousal Tx, to compare these rates with the corresponding rates in living-related, livingunrelated, and parental donor Tx in our center, and to compare the results of wife to husband (W to H) and husband to wife (H to W) kidney Tx.

Rethinking chronic allograft nephropathy: the concept of accelerated senescence.

Rethinking chronic allograft nephropathy: the concept of accelerated senescence.

Acute rejection of renal allografts: Mechanistic insights and therapeutic options

Case presentation A 44-year-old white woman was admitted to The New York Hospital for a living-donor renal transplant from her husband. One and one-half years prior to admission for transplantation, she was found to have advanced renal failure; renal biopsy at that time revealed crescentic glomerulonephritis. The patient was started on maintenance hemodialysis one year prior to admission for transplantation. Pre-transplantation serology studies were negative for hepatitis B and hepatitis C virus. The recipient and donor were cytomegalovirus positive. The HLA type of the recipient was A2, All, B51, B52, and DR2 and 4; the HLA type of the donor was A2, A24, B51, B62, and DR1 and 5. The recipient was preconditioned with a regimen of donor-specific transfusions and cyclosporine. Donor-specific T- and B-cell crossmatches, including the flow cytometry crossmatch, were negative, and the patient underwent renal transplantation from her spousal donor. The immunosuppressive regimen comprised cyclosporine (10 mg/kg/day, in two divided doses), azathioprine, and corticosteroids. The renal transplant functioned immediately. The patient's serum creatinine decreased from a pretransplant value of 14.6 mg/dl to 1.0 mg/dl by the second postoperative day and remained at that level until day 5 post transplantation. On postoperative day 6, her serum creatinine increased to 2.8 mg/dl. A renal scan showed decreased uptake, and the renal sonogram did not reveal an obstruction. A diagnosis of acute rejection was made, and the patient received a course of steroid pulse therapy (250mg intravenously, twice daily for 3 days). Her serum creatinine level peaked at 5.4 mg/dl on day 9 post transplantation. The patient responded to pulse therapy, and the serum creatinine level declined until day 15. A percutaneous core needle biopsy disclosed changes consistent with acute cellular rejection. The renal biopsy material was processed for mRNA phenotyping by reverse-transcriptase polymerase chain reaction (RT-PCR). Following a second course of steroid pulse therapy, the patient's serum creatinine declined to 1.5 mg/dl, and she was discharged from the hospital on day 20 post transplantation. Her medications at that time included the following immunosuppressants: cyclosporine, 250mg orally, twice daily; azathioprine, 150mg orally each day; and prednisone, 30mg orally twice daily. Her whole-blood cyclosporine level (determined with the monoclonal antibody specific for the parent compound) ranged from 90 ng/ml to 360 ng/ml during the transplant hospitalization. The patient is being followed in the transplant clinic, and her serum creatinine values were 1.1, 1.3, 1.5 and 1.6 mg/dl four, three, two, and one year ago, respectively.

Kidney Transplantation from Spousal Donors

Kidney transplantation has become a routine and efficient treatment for end-stage renal disease.1 However, a severe shortage of cadaveric kidneys has hampered wider use of this technique and is perhaps the most important obstacle facing transplantation today. As a consequence, transplantation surgeons now take kidneys from donors who might have been passed over a decade ago because of older age or vascular diseases. Using such donors increases the odds that the grafted kidney will have a delay in function and a poor long-term outcome.2 Although cadaveric kidneys are used in the majority of transplantations, living related donors are an important . . .