Strategies to increase living donor kidney transplants

There is an insufficient supply of deceased donor kidneys for transplantation. One solution is to increase the number of living donor kidney transplants. Our kidney transplant database was reviewed for 3 periods of 12 months each, separated by 5 years, to show the trends in kidney transplant donor sources and the influence of biologically unrelated living renal donors, minimally invasive living renal donor surgery, transplantation of ABO-incompatible kidneys from living donors, and transplantation in spite of positive cross-matches on the numbers of renal transplants and 1-year kidney transplant survival rates at our center. When results for 1993 were compared with 2003, the annual number of living donor renal transplants increased from 25 to 86, and the annual number of deceased donor renal transplants decreased from 108 to 63. The total number of kidney transplants increased by 12%. However, 1-year living donor kidney transplant survivals were not significantly different (94% for transplants done in 1993 vs 98% for transplants done in 2003). The strategies of living donor renal transplants from genetically unrelated donors, ABO-incompatible donors, and cross-match positive donors as well as the introduction of hand-assisted laparoscopic donor nephrectomy increased the number of living renal donor renal transplants at our center without compromising short-term kidney transplant survival rates.