Living or deceased donor kidney transplants for candidates with significant extrarenal morbidity

Individuals with end-stage renal disease (ESRD) must weigh the benefits and risks of dialysis vs. a transplant. However, if the patient has extrarenal morbidity, survival may be limited. We have recommended that, when possible, recipients have a living donor (LD) transplant. However, it could be argued that for recipients with extrarenal morbidity, the potential benefit does not justify the donor risks and that, therefore, recipients with increased risks should be denied an LD transplant.

We studied the outcome of LD vs. deceased donor (DD) transplants in recipients with extrarenal morbidity. For recipients with extrarenal morbidity, patient survival (p < 0.01) and graft survival (p < 0.01) rates were significantly better for LD (vs. DD) transplant recipients. We found no difference in death-censored graft survival rates.

Kidney transplant recipients with extrarenal morbidity benefit from an LD transplant. Both donor and recipient informed consent is important.