Background/Purpose: Solid organ txs from LDs provide better outcome results than from DDs. We analyzed the cumulative US LD tx experience since UNOS inception. The study purpose was to determine differences in outcome according to organ type, tx era and adult vs. pediatric txs.

Methods: From 10/1987 to 12/2015, information on 140,156 LD txs in the US was reported to UNOS. Of those, 128,904 (92%) txs went to adult and 11,252 (8%) to pediatric recipients. The following LD txs were performed by organ: kidney, 134,074 (95.7%); liver, 5,671 (4%); lung, 254 (0.2%); pancreas, 73 (0.1%); intestine, 43; (domino) heart, 41. The distribution of LD kidney vs liver txs in adults was 97% and 3%; in children, 85% and 14%.

The 28-year time interval was divided into 4 eras (1987-94; 1995-01; 2002-08; 2009-15). Uni- and multivariate analyses were performed by organ and over time; survival times were estimated according to Kaplan-Meier.

Results: Kidney: The number of adult LD kidney txs has increased over time; in contrast, the number of pediatric txs has remained stagnant. The graft half-lives have significantly improved between the first and last era: in adults, from 7.0 to > 14.3 yrs; in children, from 6.6 to > 13.0 yrs. Liver: Proportionally, more LD liver txs were performed in children. The number of adult LD liver transplants has remained stagnant; the number of pediatric txs has decreased over time. Graft half-lives have significantly improved between the first and last era: for adults, from 8.0 to > 13.2 yrs; for children, from 13.5 to > 15.0 yrs. Others: The numbers of LD pancreas, intestinal and lung txs has decreased over time; only for adult LD intestinal txs have half-lives been significantly higher than for DD txs.

Summary/Conclusion: Over the past 28 years, (1) LDs were successfully used for all types of solid organ txs in both adults and children; (2) the best long-term graft survival was for LD liver txs, poorest for lung and intestinal txs; (4) for both kidney and liver txs, graft half-lives were significantly higher for LDs than DDs; (3) the number of LD kidney and liver txs has significantly declined in children over time. An individual approach is warranted for every tx candidate who has a potential LD, carefully weighing the risks and benefits for both donor and recipient, specifically for non-kidney and non-liver txs.

CITATION INFORMATION: Gruessner R, Laftavi M, Whittaker V, Pankwycz O, Acun Z, Gruessner A. The Cumulative United States Experience with Transplants (Txs) from Living Donors (LDs): 140,156 LD Txs in 28 Years. Am J Transplant. 2017;17 (suppl 3).

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