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There exists a gender disparity in kidney donation. ABO-incompatible renal donation widened the donor pool. The studies evaluating the impact of spousal and non-spousal donation, HLA mismatches and ABO incompatibility on long-term patient and graft survival are scarce.
This is an evidence-based observational study on 1173 live renal transplants done in a single centre in Northern India between 2009 and 2019. Descriptive analytics was done among spousal and non-spousal recipients. The chi-square test of association was done to find association and concordance of discrimination between four outcomes (alive with functioning graft, death with functioning graft, alive with graft loss and death with graft loss) with ABO compatibility and HLA mismatches among spousal and non-spousal recipients. The non- parametric Mann-Whitney test was done to find the significance of median survival years. Survival analysis was done by parametric reliability model identifying location, scale and threshold parameters, from which year-wise prediction for the probability of survival was found.
Out of 1173 live renal transplantation done between 2009 and 2019, 457 (39%) were spousal recipients [388 husbands and 69 wives] and 716 (61%) were non-spousal recipients. Among non-spousal recipients (all donors were first-degree relatives), 28 % were males (331) and 8.2% of females (97) received kidneys from their mothers. Overall the male and female recipients were 92% and 8 %. ABO incompatible kidney transplants were 104 (8.9%). The trend of female donations increased from 29 per annum in 2009 to 2013 and to 35 per annum from 2014 to 2019 after the introduction of ABO-incompatible renal transplants in 2013. There was a significantly higher proportion of ABO-incompatible renal transplants in Spousal recipients (66/457,14.8% Vs 47/716,6.3%,p<0.01). The median (IQR) age (in years) of non-spousal and spousal recipients were 28 (23,35) and 42 (36.48), which was lower when compared with their donor age (IQR), 40(33,36) and 50(44,57) respectively. Overall 86% were alive with functioning graft, 7.5% were dead with functioning graft, 4.8 % were alive with graft loss and 1.7% died with failed graft by 10 years. Among non-spousal and spousal recipients, at 10 years, alive with functioning graft was noted in 85% Vs 86%, death with functioning graft was noted in 7.4% vs 7.8%, alive with graft loss was noted in 5.8% Vs 3.2%, and death with graft loss noted in 1.2% vs 2.6%. Among non-spousal recipients, the majority were ABO compatible with 3/6 HLA mismatch [378/716,53%], within which 86% were alive without graft loss. Among those with 0/6 HLA mismatch and ABO compatible transplants [18/716,3%], all were alive without graft loss till the last follow-up [p value 0.08 (alpha 0.10)]. Among spousal donation, the majority were ABO compatible with 5/6 HLA mismatches [136/457, 29%], within which 88% were alive without graft loss. Among 6/6 HLA mismatches with ABO-incompatible transplants [22/457],86% were alive without graft loss until the last follow-up [p value 0.85]. The median (IQR) survival years among non-spousal and spousal renal recipients were 5.2 years (3.1,7.6) and 4.7 (2.6,7.0) years (p=0.004). The probability of patient survival in non-spousal vs spousal recipients till 5, 7 and 10 years were 92% Vs 89% (P<0.05), 89% vs 87% (p<0.05), 85% vs 83% (p= 0.1). The survival followed three parametric Weibull distributions with shape parameters above 1(1.0635 CI 0.84 to 1.34) proving considerable long-term survival.
No difference was noted among patient survival between spousal and non-spousal recipients till 10 years of follow-up. HLA mismatches and ABO incompatibility does have impact on long term graft and patient survival.