Nephrology Dialysis Transplantation, Vol 12, Issue 9 1940-1948, Copyright © 1997 by Oxford University Press
I Binet, A Bock, P Vogelbach, T Gasser, A Kiss, F Brunner and G Thiel
Background. The growing shortage of cadaver kidneys,
the limited possibilities to expand the living related donor pool and the
good results obtained in our centre with poorly matched cadaver kidneys,
led us in 1991 to begin accepting highly motivated, unrelated, living
kidney donors who had a strong emotional bond with the recipients.
Methods. Between 1 January 1991 and 1 January 1996, 46
potential living kidney donors and their emotionally related recipients
were evaluated. Twenty-three cases were accepted for renal transplantation
after thorough somatic and psychological evaluation. The mean
post-transplant follow-up until 1 April 1996 was of 28±3 months.
Compatible blood groups and a negative cross-match were mandatory, but no
minimal HLA matching was required. Results. There was
a 50% drop-out rate following the initial screening. The main reasons for
not performing transplantation were immunological contraindications in 39%
of the cases, somatic in 30.5%, psychological in 26% and socioeconomic in
4.5%. In the accepted group of recipients, 48% (11/23) received transplants
without chronic dialysis. Donor survival was 91%; two deaths unrelated to
nephrectomy occurred 1 year after donation. The 2-year actuarial recipient
and graft survivals were 100% and 91% respectively, compared to 99%
(recipients) and 93% (grafts) in the non-HLA-identical living related
kidney transplant group, and to 93% (recipients) and 83% (grafts) in the
cadaver kidney transplant group. Recipient rehabilitation was completed
after 4±1 months. Emotionally related donors returned to work
5±2 weeks after nephrectomy, and no donor regretted his
decision, even in the case of failure. Conclusions.
Kidney transplantation from emotionally related living donors represents a
valuable option, allowing more patients with end-stage renal disease to
avoid chronic dialysis. Recipient and graft outcome were superior to
cadaver kidney transplantation. Motivated and emotionally related donors
should be allowed to donate one of their kidneys provided that they are
carefully selected and thoroughly informed. Keywords:
kidney transplantation; unrelated living donor; emotionally related donor
ORIGINAL ARTICLES
Outcome in emotionally related living kidney donor transplantation
Divisions of Nephrology and Psychosomatic, Department of Medicine, Department of Surgery and Division of Urology, Kantonsspital Basel, Switzerland; Corresponding author at: Abteilung fur Nephrologie, Kantonsspital Basel, Petergraben 4, CH-4031 Basel, Schweiz
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