PMID- 12605117
OWN - NLM
STAT- MEDLINE
DCOM- 20030320
LR  - 20220318
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 75
IP  - 4
DP  - 2003 Feb 27
TI  - Does cadaveric donor renal transplantation ever provide better outcomes than 
      live-donor renal transplantation?
PG  - 494-500
AB  - BACKGROUND: Live donor renal transplantation (LRT) now comprises more than 40% of 
      all kidney transplants performed in the United States. Many patients on the 
      cadaveric waiting list have a prospective live kidney donor. This study 
      determines whether cadaveric donor renal transplantation (CRT) can demonstrate 
      better outcomes than LRT. METHODS: From the United States Renal Data System 
      registry, 31,909 adult recipients of a first-time kidney transplant from 1995 to 
      1998 were analyzed. Recipients were followed until December 31, 2000. RESULTS: 
      CRT, more human leukocyte antigen (HLA) mismatches, increased donor age, cold 
      ischemia time greater than 24 hr, African American recipient, and a history of 
      diabetic nephropathy all increased the risk of graft failure, return to dialysis, 
      and death. Nevertheless, in specific circumstances, CRT could provide better 
      outcomes than LRT. For example, in recipients aged 18 to 59 years with a 
      hypothetical live kidney donor aged 50 years and four HLA mismatches, the 
      relative risk of graft loss with LRT is comparable or increased compared with CRT 
      if the cadaveric kidney donor is much younger or with fewer HLA mismatches. On 
      the other hand, for recipients aged 60 years or older, CRT never provides better 
      outcomes than LRT. All analyses were adjusted for recipient race, gender, and 
      history of diabetic nephropathy. There were no significant interactions among 
      donor type, HLA mismatches, donor age, and cold ischemia time. CONCLUSIONS: The 
      elderly recipient with an imminent LRT should never be offered CRT. A combination 
      of recipient and donor factors can make CRT preferable to LRT in younger 
      patients.
FAU - Mandal, Aloke K
AU  - Mandal AK
AD  - Division of Abdominal Organ Transplantation, Department of Surgery, Oregon Health 
      and Science University, Portland, OR 97201-3098, USA. mandala@ohsu.edu
FAU - Snyder, Jon J
AU  - Snyder JJ
FAU - Gilbertson, David T
AU  - Gilbertson DT
FAU - Collins, Allan J
AU  - Collins AJ
FAU - Silkensen, John R
AU  - Silkensen JR
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
SB  - IM
CIN - J Urol. 2003 Sep;170(3):1054-5. PMID: 12926438
MH  - Adolescent
MH  - Adult
MH  - Age Distribution
MH  - Cadaver
MH  - Cold Temperature
MH  - Female
MH  - Graft Survival
MH  - Humans
MH  - Ischemia
MH  - Kidney Transplantation/*mortality
MH  - *Living Donors
MH  - Male
MH  - Middle Aged
MH  - Risk Factors
MH  - Treatment Outcome
MH  - United States/epidemiology
EDAT- 2003/02/28 04:00
MHDA- 2003/03/21 04:00
CRDT- 2003/02/28 04:00
PHST- 2003/02/28 04:00 [pubmed]
PHST- 2003/03/21 04:00 [medline]
PHST- 2003/02/28 04:00 [entrez]
AID - 10.1097/01.TP.0000048381.48473.D1 [doi]
PST - ppublish
SO  - Transplantation. 2003 Feb 27;75(4):494-500. doi: 
      10.1097/01.TP.0000048381.48473.D1.