Incompatible Live-Donor Kidney Transplant Improves Survival, Compared to Waiting

Patients who receive a kidney from an HLA-incompatible live donor have better survival than those who receive a deceased-donor transplant or who remain on the waiting list, concludes a study in The New England Journal of Medicine.

The study included 1025 adults who received kidney transplants from HLA-incompatible live donors at 22 US centers between 1997 and 2011. They were matched to control groups of patients who either remained on the waiting list or received a kidney from a deceased donor, and patients who remained on the waiting list without receiving a transplant.

One-year survival was 95.0 percent for patients who received kidneys from HLA-incompatible live donors versus 94.0 percent for waiting-list-or-transplant controls and 89.6 percent for the waiting-list-only controls. The differences remained significant through 8 years, when survival was 76.5, 62.9, and 43.9 percent, respectively.

The 8-year survival advantage of live-donor kidney transplant remained significant at all donor-specific antibody levels. For patients with a positive Luminex assay but a negative flow-cytometric cross-match, transplant from an incompatible live donor increased survival by 24.2 percentage points compared to waiting-list-or-transplant controls and by 42.1 percentage points for waiting-list-alone controls. The differences were 13.0 and 33.3 percentage points for patients with a positive flow-cytometric cross-match but a negative cytotoxic cross-match, and 9.5 and 27.3 percentage points for those with a positive cytotoxic cross-match, respectively. The findings were similar on sensitivity analysis excluding patients from the highest-volume center [Orandi BJ, et al. Survival benefit with kidney transplants from HLA-incompatible live donors. N Engl J Med 2016; 374: 940–950].