Use of living unrelated kidney donors

Kidneys from living donors are widely used to treat endstage renal disease (ESRD) in transplant centers throughout the Asian countries. In Taiwan, it is estimated that there are 1000 patients waiting for renal transplantation from a pool of 5000 hemodialysis patients. However, in 1991, only 18 of 116 kidney transplants were from living related donors. Although patient and graft survival for living related donor and living unrelated donor transplants has been consistently better than that for cadaveric transplants, the use of living unrelated donors remains controversial. Since there has been a dramatic increase in ESRD patients willing to have a renal transplant, spouses should be considered as living unrelated donors for renal transplantation. In Taiwan, the law declares that a spouse can be a kidney donor if: (1) the marriage is more than 3 years old and (2) the couple has at least one child. In this study, we report studies on the donor-recipient crossmatch test and mixed lymphocyte reaction (MLR) using spouse donors in 147 patients. Furthermore, the correlation of the in vitro immunological reactivity with clinical outcome using spouse kidney donors will be discussed.