The Role of Various Risk Factors in Living Related Donor Renal Transplant Success

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Abstract
Assessment of living related donor (LRD) survival statistics offers the opportunity to gauge the effects of recipient characteristics without the perturbations of viability, function, and antigen sharing that are inherent in cadaveric organ grafting. From Jan. 1, 1969 to Jan. 1, 1979, 167 LRD grafts were performed. Crude patient survival at 1 yr is 92% and 84% at 5 yr. Graft function at 1 yr is 79% and at 5 yr is 64%. One yr patient survival has steadily improved: 1969-73, 83%; 1973-75; 91%; 1975-79, 98%. Graft survival improved during the first 2 periods and has since remained unchanged. HLA identical grafts showed the expected advantage compared with single haplotype grafts (93 vs. 74%). Recipient age was without effect until 50 yr, all younger subgroups having 1-yr patient survival of 92-95%, while those older than 50 had a 1 yr survival of 60%. Juvenile diabetes was associated with a 1 yr patient survival of 85% and graft survival of 74%. Glomerulonephritis did not affect early graft survival statistics, but there was a greater frequency of graft loss after 2.5 yr, with function at 5 yr of 51 vs. 68% for recipients with all other diagnoses. Cadaveric graft statistics vary with recipient race when adjusted to exclude older patients and diabetics: white recipient 1-yr graft survival 74%, black 38%. No meaningful difference exists among LRD recipients as to graft function, but there is a trend toward improved black patient survival. There may not be an inherent difference in immune response to genetically similar grafts, but the disparate results with racially mixed donor-recipient combinations rests with other factors.