Spousal Donor Kidney Transplantation Outcomes

New Orleans—Even with poor histocompatibility and older age, it is known that the rate of graft survival in transplantations involving spousal kidney donation is similar to that of living related donor kidney transplantation. Marriage is the distinctive feature in spousal kidney donation (SKD) and other living unrelated kidney donation. Married people live longer and have better health than single people have; however, there are few data on the effect of marriage on graft outcome in transplantation.

To examine the association of marriage on graft survival, Mi-yeon Yu, MD, and colleagues conducted a retrospective cohort study that included patients who underwent living donor kidney transplantation at Seoul National University Hospital between January 2000 and February 2016. They reported results of the study during a poster session at Kidney Week in a poster titled The Effects of Marriage Duration after Transplantation on Graft Outcomes in Spousal Donor Kidney Transplantation.

The patients were stratified into three groups: spousal donor kidney transplantation, living related donor kidney transplantation, and other living unrelated donor kidney transplantation. Marriage duration after transplantation for patients with spousal donor was surveyed by personal interview and telephone questionnaire. The primary outcomes of interest were biopsy proven acute rejection, graft survival, and patient survival.

The total cohort included 824 living donor transplantation recipients. Living related donor kidney transplantation was the most common (68.8%), followed by spousal donor kidney transplantation (22.3%), and living unrelated donor kidney transplantation (8.9%). Recipients in the spousal donor group received their allografts from donors with older age (median, 46.0 years), more female sex (65.8%), more ABO incompatibilities, and higher human leukocyte antigen mismatches compared with recipients of living related donor kidneys and living unrelated donor kidneys. Recipients of spousal donor kidneys also tended to receive more pre-emptive transplantation.

In Kaplan-Meier curve analysis, recipients of spousal kidney donors had lower biopsy proven acute rejection rates compared with living related donor kidney recipients. There were no differences in graft survival and patient survival between those two groups. Among the patients in the spousal donor transplantation group, longer duration of marriage after transplantation was a novel protective factor for biopsy proven acute rejection; the benefit persisted after adjustment (adjusted hazard ratio, 0.244; 95% confidence interval, 0.121-0.493; P<.001). Marriage duration after transplantation did not affect graft or patient survival.

In conclusion, the researchers said, “We demonstrated that graft and patient survival rate of spousal donor kidney transplantation was not inferior to living related donor transplantation, despite their immunologic risk. Moreover, we found that longer marriage duration after transplantation was a novel protective factor for biopsy proven acute rejection–free survival rate. Not only immunologic similarity but also habitual similarity between donor and recipient may influence graft outcome after kidney transplantation.”

Source: Yu My, Park JI, Cho H, Kim YS, Lee H. The effects of marriage duration after transplantation on graft outcomes in spousal donor kidney transplantation. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2017, New Orleans, Louisiana, November 2, 2017.