Background. Only few data is available about long-term immunologic outcomes of living kidney transplantation (KTx) depending on the donor-recepient relationship.

Patients and methods. This single center retrospective long-term observational study included related (parent-to-child or siblings) and unrelated adult living donor kidney transplant recipients between 2000 and 2014 (n=335) (Table 1). DSA analysis and allograft biopsies were performed for clinically suspected rejections. Data analysis included patient and graft survival, biopsy proven rejection episodes (T-cell mediated (TCMR) or antibody mediated (ABMR)) and development of de-novo DSA. Outcome data were assessed over a period of maximum 14 years.

Results. Graft survival did not differ significantly among the groups (Fig 1A). Sibling-to-sibling pares trend to result in a lower incidence of TCMR (Fig 1-B). There was no significant difference between the groups in terms of ABMR (Fig 1-C). The rates of de novo DSA tended to be higher in parent-to-child pares and non-related KTx (both 26% after 7 years vs. 11% in siblings, p=0.102). The multivariate analysis adjusted for age, AB0-incompatibility, HLA (A, B, DR)-mismatch and donor-recipient relationship identified the donation by a sibling as an independent protective factor for TCMR (HR 0.347, p=0.018). The number of HLA-mismatches was shown to be the only independent risk factor for de-novo DSA (HR 1.21, p=0.012).

Conclusion. Not only HLA-mismatch but also donor-recepient relationship does influence the immunological outcome significantly. Our data suggest donation by a sibling is an independent protective factor for TCMR.

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