AUTHOR=El-Rifai Rasha , Bregman Adam , Klomjit Nattawat , Spong Richard , Jackson Scott , Nachman Patrick H. , Riad Samy 

TITLE=Living Donor Kidney Transplant in Recipients With Glomerulonephritis: Donor Recipient Biologic Relationship and Allograft Outcomes

JOURNAL=Transplant International

VOLUME=Volume 36 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11068

DOI=10.3389/ti.2023.11068

ISSN=1432-2277

ABSTRACT=Using the Scientific Registry of Transplant Recipient, we examined the association between donor-recipient biologic relationship and recipient and allograft survival among recipients with GN. Four GN's were studied: membranous nephropathy, IgA, lupus associated nephritis, and focal segmental glomerulosclerosis (FSGS). We identified all adult primary living donor recipients between 2000-2017 (n=19,668): related (n=10,437); unrelated (n=9,231). Kaplan-Meier curves were generated for recipient and death-censored graft survival through ten years post-transplant. Multivariable Cox proportional hazard model was used to examine the association between donor-recipient relationship and outcomes of interest. 
There was an increased risk for acute rejection by 12 months post-transplant among the unrelated compared to the related group in IgA (10.1% vs 6.5%, p<0.001), FSGS (12.1% vs 10%, p-0.016), and lupus nephritis (11.8% vs 9.2%; p-0.049). In the multivariable models, biological donor-recipient relationship was not associated with worse recipient or graft survival.
In this large cohort study, biologic donor-recipient relationship was associated with lower rejection rates. Additionally, it was not associated with worse long-term recipient or graft survival in any of the studied groups. These findings are consistent with the known benefits of living-related-donor kidney transplant and counters the reports of potential adverse impact of donor recipient biologic relationship on allograft outcomes.