594
The number of available cadaver kidneys is insufficient to supply the needs of waiting patients. Only recently, LURD have been recognized as potential source of kidneys. We report our experience with 1st. LURD transplants in adults from 1985-94, when compared to cadaver and one-haplotype living related donors after 10 years. During this period we performed: 166 LURD (23,8%), 309 (44,3%) one-haplotype living related (LRD), and 222 (31,9%) cadaver (CD) transplants. Nine pt. were excluded due to missing data. Afro-origin pt. received more CD kidneys (20,3%). LRD were younger (36y), and CD received more CyA (75,9%) than the others groups. At the time of analysis, 437 pt. (62,7%) were alive with a functioning graft, 97 (13,9%) had died, and 163 (23,4%) had lost their grafts. Mean follow-up time was 69,8 months. Ten-year pt. survival (PS) was similar between one-haplotype LRD (91%) and LURD (87%) when CyA was used (NS). Without CyA, ten-year PS was higher in LRD recipients when compared to LURD and CD (87% x 72% x 64%, p=0,003 and 0,0001). LURD and CD had better PS when CyA was used (87% x 72% and 77% x 64%, p=0,01 and 0,05). Infection was the major cause of death in CD (61%) than in the others groups either at the 1st. (0,001) or the 10th year (p=0,02). Mortality of CD recipients was higher than of LRD and LURD mainly at the 1st year. Ten-year graft survival (GS) with and without CyA was similar between LRD and LURD (69% x 83% and 59% x 56%, p=0,11 and 0,56) and higher than in CD recipients (83% x 50% and 56% x 30%, p=0,003 and 0,001). LURD and CD ten-year GS was also higher when CyA was used (p=0,0003 and 0,01), but was similar in LRD pt. (p=0,17). Excluding losses that occurred at the first year, GS was better with CyA in LURD than in CD (88% x 73%, p=0,003), and better in CD than in LRD (73% x 62%, p=0,01). Without CyA, results were similar (68% x 69% x 48%, p=NS). LURD and CD GS at 10 years was superior with CyA than without CyA (88% x 68% and 73% x 69%, p=0,0001 and 0,01), but no difference was detect in LRD with or without CyA (p=0,10). Chronic rejection was the main cause of graft loss in the 3 groups, and occurred at the same rate (36% x 49% x 46%, p=NS). We concluded that LURD transplantation has the same patient survival than one-haplotype LRD transplantation and is superior to cadaver transplantation, when CyA is used. We also concluded that LURD transplantation has a similar graft survival than LRD and CD recipients with and without CyA. The prevalence of chronic rejection is the same in CD, LURD and one-haplotype LRD. In the context of scarcity of cadaver donors, LURD are a valuable option to kidney transplantation.