It is well known that graft survival rate in spousal donor kidney transplantation (SKT) is similar to that of living related donor kidney transplantation (LRKT) despite poor histocompatibility and older age. Marriage is a distinctive feature of spousal kidney donation and other living unrelated kidney donation. Although married people live longer and healthier than singles due to their closest environmental and habitual relationship, the effect of marriage on graft outcome has not been evaluated. In a retrospective cohort study, we recruited patients undergone living donor kidney transplantation at Seoul National University Hospital between January 2000 and February 2016. We divided patients into three groups as follows: SKT, LRKT and other living unrelated kidney donor transplantation (LURKT). For spousal donors, the marriage duration (MD) was surveyed by personal interview. We defined the MD/age as MD per age at the time of KT. Outcome was biopsy proven acute rejection (BPAR), graft survival (GS) and patient survival (PS). A total of 824 living donor kidney transplantation recipients were included. Among them, LRKT was most common with 68.8 %, followed by SKT with 22.3 %, and LURKT with 8.9 %. SKT group received their allografts from donors with older age (median age 46.0), more female sex (65.8%), and higher HLA mismatches than other groups. In the Kaplan-Meier curve, SKT revealed lower BPAR free survival rate than LRKT, whereas GS and PS were not different. In SKT group, median MD was 22 years and median MD/age was 0.458. In overall, MD/age did not affect outcomes. However, longer MD/age was protective for 1-year BPAR even after adjustment (adjusted HR 0.949, 95% CI 0.905-0.995, P = 0.031), in SKT recipients with ABO compatible and older than 40 years. We demonstrated that outcomes of SKT were not inferior to LRKT, rather BPAR free survival was more favorable than LRKT. Notably, SKT recipients with longer age-adjusted marriage duration was protective for BPAR in spite of their immunologic risks. Not only immunologic similarity but also habitual similarity between donor and recipient may influence on graft outcome after kidney transplantation.

CITATION INFORMATION: Yu M., Park J., Cho H., Ha J., Ahn C., Kim Y., Lee H. The Effects of Age-Adjusted Marriage Duration on Graft Outcomes in Spousal Donor Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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