Attitudes of black South Africans to living related kidney transplantation

Between September 1992 and April 2003, 96 patients in chronic renal failure had 134 potential related living donors. The aim of this study was to determine the factors that influence living related kidney transplantation among black South Africans.

Potential recipients and donors were screened for suitability to donate or receive kidneys. The relationship of the donor to the recipient was documented.

Ninety-six potential recipients of median age 32 years (range, 7 to 53) and a female to male ratio of 1:1.6 had potential related donation from 47 sisters, 33 brothers, 27 mothers, 8 fathers, and 11 children. Eight potential donors were from cousins, spouses, stepbrothers, and friends. One, two, or three potential donors per recipient were counted among 54, 19, and 10 recipients, respectively. Contraindications to transplantation in 45 potential donors were ABO incompatibility (n = 19); hypertension (n = 11); HIV positivity (n = 10); and one each for nephrotic syndrome, gastric cancer, Hepatitis B, withdrawal, and a single functioning kidney. Thirty-five patients were transplanted from relatives. Although HLA-A, B, and DR antigens were studied in transplanted patients using both serologic and polymerase chain reaction-sequence-specific oligonucleotide methods, HLA matching was not used for donor selection. Only two living related pairs were HLA identical. Actual 1-year graft survival after transplantation was 95%. In conclusion, the concept of related living donation is acceptable among black South Africans and the number of donors per recipient suggests that HLA matching can be improved.