Comparing Outcomes of Spousal Kidney Transplants with Living-Related Donors in DSA-Positive Recipients: Is the Risk...

The number of spousal donor transplantation (SDT) has increased since the early 1990s. Although the SDT is performed successfully today, several concerns remain regarding compatibility. In particular, in husband-to-wife donations, donor-specific antibodies (DSAs) positivity may develop as a consequence of previous pregnancies, thereby posing a risk to graft survival. However, data on outcomes in recipients with a history of pregnancy and the development of DSA are limited. In this study, we aimed to compare the outcomes of transplantation between high-risk spouses and transplantation from living donors.

This study was conducted in our nephrology and transplantation department. It involved 59 spousal donors and 72 living-related donors with DSAs who were older than >18 years of age. We evaluated the consecutive patients who had kidney transplantation between 2010 and 2020.

We analyzed data from 59 SDTs with 72 living-related donor transplants (LRDTs) with DSA positivity. Within the first year after transplantation, the acute rejection rate was highest in the husband-to-wife (H-to-W) group (p = 0.01). Compared with LRDT, H-to-W transplants were associated with an increased risk of acute rejection (OR [95% CI]: 4.231 [1.122-15.957], p = 0.03). Cox regression analysis demonstrated a higher risk of rejection in kidney transplants from H to W within the first year of kidney transplantation (HR: 3.734 [95% CI: 1.087-12.825], p = 0.03). There was no increase in creatinine doubling time between groups and no increase in risk of rejection in 5 years. During the follow-up period, graft loss was reported in 3 patients, comprising 2 in the LRDT group and 1 in the W-to-H group.

SDT, particularly when DSA has developed, appears to be associated with a higher risk of rejection during the first year compared with LRDT with similar DSA. Nevertheless, similar graft survival suggests that H-to-W spousal transplants appear to be safe in the long term.