The Results of Spousal Donor Kidney Transplantation Via Exchange Donor Program and Direct Spousal Donor Kidney Transplantation in Living Donor Kidney Transplantation: Single Center Experience

Jin Kyu Lim; Min Soo Kim; Oh Jung Kwon

doi:10.4285/jkstn.2009.23.2.154

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Lim, Kim, and Kwon: The Results of Spousal Donor Kidney Transplantation Via Exchange Donor Program and Direct Spousal Donor Kidney Transplantation in Living Donor Kidney Transplantation: Single Center Experience

Original Article

J Korean Soc Transplant 2009;23(2):154-160.

Published online: 11 June 2009

DOI: https://doi.org/10.4285/jkstn.2009.23.2.154

The Results of Spousal Donor Kidney Transplantation Via Exchange Donor Program and Direct Spousal Donor Kidney Transplantation in Living Donor Kidney Transplantation: Single Center Experience

Jin Kyu Lim, M.D., Min Soo Kim, M.D., Oh Jung Kwon, M.D.

Departments of Surgery, College of Medicine, Hanyang University, Seoul, Korea

책임저자：권오정, 서울시 성동구 행당동 17 한양대학교병원 외과, 133-600 Tel: 02-2290-8460, Fax: 02-2281-0224 E-mail: ojkwon@hanyang.ac.kr

Received 27 May 200928 August 2009 Accepted 28 August 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

The shortage of living related and deceased donor groups is one of the major problems of kidney transplantation. We examined the results of spouse and spousal exchange among living kidney transplantation.

Methods:

Living donor kidney transplants at a single center between 1991 and 2005 were studied, retrospectively (n=593). We compared the graft survival rates of 24 spousal, 53 spousal exchange transplantations with those of 125 sibling, 142 other living related donor (LRD) or 249 other living unrelated donor (LURD) procedures. We analyzed graft survival rate, acute rejection rate among each groups.

Results:

The 5, 10 year graft survival rates of spousal donor were 75.0%, 69.2%, those of other LURD and spousal exchange were 74.6%, 64.5% (P=0.80) and 86.6%, 84.8% (P=0.11), those of sibling and other LRD were 82.3%, 75.9% (P=0.37) and 75.7%, 65.4% (P=0.84). Spousal exchange donor were more good graft survival rates rather than other LRD and LURD (P=0.01, 0.01). Acute rejection rates of spousal donor were not significant difference among sibling, other LRD and LURD groups. But acute rejection rates of spousal exchange donor (22.6%) were lower than spousal (45.8%) and other LURD (38.7%) (P=0.04, 0.04). In the multivariate analysis of donor groups, other LRD and LURD groups were associated with a high relative odds of graft survival (odds ratio 2.88±0.38 (P=0.02), 2.35±0.37 (P=0.01)) compared to spousal exchange donor groups.

Conclusions:

The spousal exchange donors had more good graft survival rates than other LRD and LURD groups and spousal donors were as good as other living donors. We expect that the spousal and spousal exchange transplantations are one of the good programs for donor pool expansion.

Keywords: Spousal donor, Kidney transplantation, Spousal exchange donor

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Fig. 1.

Graft survival rates of living donor kidney transplantation. LRD: Living related donor, LURD: Living unrelated donor.

Table 1.

Baseline characteristics of donor groups, n (%)

Type	Sibling	Other LRD	Spouse	Spousal exchage	Other LURD
Donor age
＜50 years	105 (84.0)∗	87 (61.3)∗^†‡	18 (75.0)	48 (90.6)^†	194 (77.9)^‡
≥50 years	20 (16.0)	55 (38.7)	6 (25.0)	5 (9.4)	55 (22.1)
Donor sex
Female	58 (46.4)∗	60 (42.3)^†	15 (62.5)^§	37 (69.8)∗^†‡	93 (37.3)^‡§
Male	67 (53.6)	82 (57.7)	9 (37.5)	16 (30.2)	156 (62.7)
Recipient age
＜50 years	119 (95.2)∗^†‡§	§110 (77.5)∗	16 (66.7)^†∥	41 (77.4)^‡	206 (82.7)^§∥
≥50 years	6 (4.8)	32 (22.5)	8 (33.3)	12 (22.6)	43 (17.3)
Recipient sex
Female	40 (32.0)	57 (40.1)	9 (37.5)	16 (30.2)	77 (30.9)
Male	85 (68.0)	85 (59.9)	15 (62.5)	37 (69.8)	172 (69.1)
Recipient HLA matching (n)	85 (68.0)	85 (59.9)	15 (62.5)	37 (69.8)	172 (69.1)
0∼2	33 (26.4)∗^†‡	22 (15.5)∗^§∥¶	15 (62.5)^†§	§ 27 (50.9)^∥	135 (54.5)^‡¶
3∼4	66 (52.8)	107 (75.4)	7 (29.2)	26 (49.1)	112 (45.0)
5∼6	26 (20.8)	13 (9.2)	2 (8.3)	0 (0.0)	2 (2.6)
Time on dialysis (year)
Preemptive	26 (20.8)∗	26 (18.3)^†	4 (16.7)	2 (3.8)∗^†‡	25 (10.0)^‡
0∼1	26 (20.8)∗57 (45.6)	26 (18.3)56 (39.4)	4 (16.7)10 (41.7)	2 (3.8)∗22 (41.5)	25 (10.0)71 (28.5)
＞1∼3	28 (22.4)	40 (28.2)	9 (37.5)	11 (20.8)	79 (31.7)
＞3	14 (11.2)	20 (14.1)	1 (4.2)	18 (34.0)	74 (29.7)
Transplant period (year)
1991∼1997	77 (61.6)∗	95 (66.9)	17 (70.8)	33 (62.3)	182 (73.1)∗
1998∼2005	48 (38.4)	47 (33.1)	7 (29.2)	20 (37.7)	67 (26.9)
Infection
Viral	13 (10.4)	16 (11.3)	6 (25.0)	6 (11.3)	37 (14.9)
Other	5 (4.0)	4 (2.8)	0 (0.0)	0 (0.0)	7 (2.8)
Fungal	2 (1.6)	1 (0.7)	0 (0.0)	0 (0.0)	3 (1.2))
Tuberculosis	0 (0.0)	2 (1.4)	0 (0.0)	1 (1.9)	2 (0.8)
Recipient BMI
＜18.5	13 (10.4)	25 (17.6)	2 (8.3)	8 (15.1)	45 (18.1)
18.5∼＜25	84 (67.2)	91 (64.1)	20 (83.3)	36 (67.9)	160 (64.3)
18.5 25 ≥25∼＜30	84 (67.2)26 (20.8)	91 (64.1)22 (15.5)	20 (83.3)2 (8.3)	36 (67.9) 7 (13.2)	160 (64.3) 38 (15.3)
≥30	26 (20.8)2 (1.6)	22 (15.5)4 (2.8)	2 (8.3)0 (0.0)	7 (13.2)2 (3.8)	38 (15.3) 6 (2.4)
Donor BMI	2 (1.6)	4 (2.8)	0 (0.0)	2 (3.8)	6 (2.4)
＜18.5	8 (6.4)∗	6 (4.2)	0 (0.0)∗	0 (0.0)	13 (5.2)
18.5∼＜25	82 (65.6)	86 (60.6)	11 (45.8)	38 (71.7)	149 (59.8)
≥25∼＜30	30 (24.0)	46 (32.4)	13 (54.2)	12 (22.6)	76 (30.5)
≥30	5 (4.0)	4 (2.8)	0 (0.0)	3 (5.7)	11 (4.4)

Abbreviations: LRD, Living related donor; LURD, Living unrelated donor.

^∗ P＜0.05 between two groups.

^† P＜0.05 between two groups.

^‡ P＜0.05 between two groups.

^§ P＜0.05 between two groups.

^∥ P＜0.05 between two groups.

^¶ P＜0.05 between two groups.

Table 2.

Graft survival rate and rate of acute rejection

	5 yr graft survival rates (%)	10 yr graft survival rates (%)	Rate of acute rejection (%)
Sibling	82.3	75.9	26.4
Other LRD	75.7	65.4∗	27.5
Spouse	75.0	69.2	45.8∗
Spousal exchange	86.8	84.8	22.6
Other LURD	74.6	64.5∗	38.7∗

Abbreviations: LRD, Living related donor; LURD, Living unrelated donor.

^∗ P＜0.05 compared to spousal exchange donor transplantation.

Table 3.

Univariate graft survival analysis of donor groups and outcomes

Type	5 yr graft survival rates (%)	10 yr graft survival rates (%)	P-value
Donor age			0.04
＜50 years	78.8	71.1
≥50 years	73.6	62.9
Donor sex			0.27
Female	75.8	66.7
Male	79.0	71.1
Recipient age			0.01
＜50 years	75.5	66.6
≥50 years	88.0	81.7
Recipient sex			0.01
Female	85.2	75.3
Male	73.7	66.0
Recipient HLA matching (n)			0.02
0∼2	73.5	64.6
3∼4	78.8	69.5
5∼6	90.6	90.6
Recipient time on dialysis (year)			0.01
Preemptive	87.0	80.4
0∼1	78.6	72.6
＞1∼3	81.5	72.9
＞3	65.9	53.4
Transplant period (year)			0.01
1991∼1997	72.0	61.6
1998∼2005	89.7	88.2
Recipient BMI			0.50
＜18.5	73.0	66.0
18.5∼＜25	77.6	69.7
＞=25∼<30	80.8	67.1
＞=30	85.7	85.7
Donor BMI			0.47
＜18.5	85.2	76.2
18.5∼＜25	76.9	69.2
＞=25∼＜30	76.7	66.5
＞=30	86.5	79.9

Univariate analysis was performed using the Kaplan-Meier method with a Log-rank test.

Table 4.

Multivariate graft survival analysis of donor groups and outcomes

Type	Graft failure (HR)	95% confid ence interval		P-value
Type	Graft failure (HR)	Lower	Upper	P-value
Donor type
Sibling	1.90	0.86	4.20	0.11
Other LRD	2.88	1.14	4.86	0.02
Spouse	2.55	0.92	7.06	0.07
Spousal exchange	1.00
Other LURD	2.35	1.35	6.14	0.01
Donor age
＜50 years	1.00
≥50 years	1.24	0.88	1.76	0.22
Recipient age
＜50 years	1.00
≥50 years	0.48	0.29	0.80	0.01
Recipient sex
Female	1.00
Male	1.44	1.03	2.01	0.04
Recipient HLA matching (n)
0∼2	1.00
3∼4	0.83	0.61	1.14	0.26
5∼6	0.28	0.11	0.71	0.01
Recipient time on dialysis (year)
Preemptive	1.00
0∼1	1.83	1.13	2.95	0.01
＞1∼3	1.88	1.10	3.23	0.02
＞3	3.33	2.11	5.25	0.01
Transplant period (year)
1991∼1997	1.00
1998∼2005	0.31	0.20	0.49	0.01

Abbreviations: LRD, Living related donor; LURD, Living unrelated donor. Multivariate analysis was performed using the Cox proportional hazard regression model. The model included adjustment for the following factors associated with graft survival in univariate analysis with P＜0.05.

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