Live donor renal transplantation in Australia 1964-1999: an evolving practice

Australia has a low cadaver organ donor (CD) rate by international standards, leading to the increasing use of live donor (LD) renal grafts.

To review the Australian experience with LD transplants from 1964 to 1999.

Data were obtained from the Australian and New Zealand Dialysis and Transplant Registry. Survival was assessed by the Kaplan-Meier method.

A total of 1584 LD and 10 252 CD transplants was performed between 1964 and 1999. While the CD rate dropped over the last decade, the LD rate increased, maintaining the overall transplantation rate. Only 3.6% of grafts before 1980 were LD, increasing to 28.4% during 1995-1999. Patient and graft survival of LD grafts was superior to CD grafts. Most LD grafts were from live related donors (LRD), most commonly parents or siblings. The number of transplants from live unrelated donors (LURD) has risen (1980-1989, n = 6; 1990-1999, n = 143), primarily due to more spousal donation, with no difference in survival between LRD and LURD groups. Grafts from older donors (> 50 years of age) increased, with no graft survival difference between donors < 50 years and donors > 50 years. LD transplants performed prior to commencement of dialysis increased, with survival similar to grafts performed after dialysis.

The pattern of renal transplantation in Australia has changed, with increasing numbers of LD transplants, growing use of unrelated and older donors, and more transplants before dialysis commences. Long-term patient and graft survival advantages have been maintained, supporting the growing use of live donors to expand the donor pool.