EPIDEMIOLOGY AND CLINICAL OUTCOMES

T.A. Sarguroh, R.R. Sen, R.R. Jagdale, J.P. Kothari, R.A. Sirsat, A. Almeida
Nephrology Section, Department Of Medicine, PD Hinduja National Hospital & Medical Research Centre, Mumbai/INDIA

Body: Introduction: Demand far exceeds the supply of kidneys for transplantation. Cadaver transplantation has not grown at a rate sufficient to cater to the demand. The Human Organ Transplantation Act in our country has considered the spouse as a legal donor. The present study examines the outcomes of spousal donor transplants. Methods: Between January 2005 and December 2009, 181 transplants were performed at this center. There were 30 spousal donor kidney transplants [Wife-to-husband 25; husband to wife 5]. During the same period, 118 genetically related donor allograft transplants were performed. The two groups were matched for demographics. All spousal donor transplant recipients received induction therapy with monoclonal or polyclonal antibodies. The other immunosuppressant protocols for both groups did not differ. The patient and graft survival rates amongst the two groups were calculated using Kaplan- Meier analysis. Results^: The mean (±SD) age was 39.4 ± 8 years and 34.06 ± 6 years for the live related groups (1) and the spousal groups (2) respectively. In all spousal transplants there were at least 4 or more HLA mismatches. The five-year patient survival rates were 68 percent for kidneys from the 119 living genetically related donors (Group 1) and 79 percent for kidneys from 30 spouses (Group 2) as per the Kaplan –Meier analysis which is shown below: The outcomes of spousal donor renal transplants was not different from that with genetically related donor transplant (P=0.3141 by Logrank Test). Conclusion: Spousal kidney transplantation illustrates analogous results with live related donor transplantation, despite genetic dissimilarity. Hence, wherever cadaver transplants are not feasible, spousal donor transplants could be a viable alternative. The availability of superior immunosuppressive agents could account for this improvement in graft survival despite poor HLA matches and should be promoted in places where cadaveric organs remain insufficient.

Disclosure: All authors have declared no conflicts of interest.