The impact of deceased versus living donor graft status on kidney transplant outcomes: A Johannesburg single-center 48 years experience of 1685 patients

Abstract

Background: This study is aimed to determine the impact of living donor (LD) versus deceased donor (DD) kidney transplantation on renal graft survival and patient overall survival rates within Johannesburg, South Africa.

Materials and methods: A retrospective assessment was conducted of all 1685 adult first kidney-alone kidney transplant recipients transplanted between the years 1966 and 2013 in a single center. The patients were divided according to the source of the transplant: LD versus DD. Demographics and post-transplantation follow-up data were determined and tabulated. Graft and overall survival plots were generated.

Results: Of the recipients enrolled, 84.1% were DD recipients and 15.9% were LD recipients. Living donor recipient status was significantly associated with younger age (p ≤ 0.0001), a higher proportion of white, Asian, or mixed race compared to black race (p ≤ 000.1), a higher proportion of urologic etiology of disease (p = 0.015), and a lower proportion with hypertension (p ≤ 0.0001) as the cause of end stage kidney disease. Results showed a decreased risk of graft failure (hazard ratio, 0.55; 95% confidence interval, 0.45-0.66) and a decreased risk of death (hazard ratio, 0.47; 95% confidence interval, 0.36-0.61) among LD graft recipients as compared to DD graft recipients.

Conclusions: In keeping with internationally reported trends, LD recipients continue to have enhanced patient and graft survival outcomes as compared to DD recipients within our local experience. This Johannesburg experience will serve as a foundation for future related studies in this region of the world.

Keywords

Graft survival / Kidney transplant / Living donors / South Africa / Survival rate

Acknowledgments

We would like acknowledge Petra Gaylard for data analysis and interpreation and Wits Donald Gordon Medical Centre for the cost of the statistical analysis.

Statement of ethics

The study was approved by the Medical Human Research Ethics Committee, University of Witwatersrand (M121186). The study was a retrospective record review over a 48 year period. According to the University of the Witwatersrand, participant consent was not required in this study. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest statement

The authors have no conflict of interest.

Funding source

This research was funded by the Wits Donald Gordon Medical Centre.

Author contributions

JF: Study concept and design, acquisition of data, critical revision of the manuscript, administrative, technical and material support, study supervision;AA: Study concept and design, drafting the manuscript, critical revision of the manuscript, administrative, technical and material support, study supervision;TM: Drafting the Manuscript, critical revision of the manuscript.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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