Background: Live kidney transplantation (LK-tx) results in a longer transplant survival and better renal function than non-living transplantation (Non-LK-tx).

Methods: We tested the reasons for that by analyzing retrospectively 892 renal transplant patients having participated in a protocol biopsy program (started at 2000, biopsies at 6, 12, and 26 weeks) with at least 1 protocol biopsy.

Results: 134 patients after LK-tx were compared to 758 patients after Non-LK-tx. Transplant failure at 10 years was seen in only 8% of LK-tx patients and 15% of Non-LK-tx (p=0.04, death-censored Kaplan-Meier analysis); their creatinine clearance (C&G) after 6 weeks and 1 year was significantly higher (median 67[range 23-140] vs 56 [14-148]; and 60 [14-131] vs 53 [13-160] mL/min, resp; p=0.001). Statistically significant differences between the groups were donor age (53 [29-74] vs 49 [5-82] yrs, p=0.001); recipient age (44 [18-69] vs 51 [19-76] yrs, p<0.001); length of dialysis treatment (18 [0-279] vs 81 [0-322] mos, p<0.001); cold ischemia time (2.3 [1.3-3.5] vs 15.4 [7.3-25.2] hrs, p<0.001); initial graft function (94 vs 67%, p<0.001); preceding tx (8 vs 14%, p=0.04); HLA miss match A+B+DR (3 [0-6] vs 2 [0-6], p<0.001); ATG induction (2 vs 10%, p=0.004); Il2 AK induction (91 vs 77%, p=0.004); cyclosporine treatment (5 vs 69%, p<0.001); tacrolimus treatment (92 vs 25%, p<0.001). No statistically significant difference was seen in the number of rejections during 6 mos post-tx (31 vs 32%, ns) and >6 mos post-tx (32 vs 25%, ns); positive PRA (3 vs 8%, ns); PRA 6-84% (2 vs 6%, ns); PRA >84% (0 vs 0.9%, ns).

Conclusion: Patients after live kidney tx had a better 10-yr transplant survival and a better early and late renal function than patients after deceased-donor tx. The life-kidney patients were younger, had a shorter length of dialysis before tx, were less often pre-transplanted, and had a shorter cold ischemia time. Patients after deceased-donor tx, however, had younger donors and a better HLA match. The very good 10-yr transplant survival in both groups may be attributed to their participation in protocol biopsies: On the one side, histologic changes in the biopsies influence treatment modifications; on the other side, these patients permitting protocol biopsies probably are a positive selection of patients with a good adherence.

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