Can the results of live donor kidney transplantation be improved?

According to an analysis of 100 consecutive kidney transplants from live donors performed at our center over a 25-month period beginning in June 1980, only two patients have died, and five other patients had graft loss from acute or chronic rejection; this resulted in an overall actuarial 2-year patient survival rate of 98% and a graft survival rate of 90%. Eighty-five of the 93 patients with functioning grafts have excellent renal function, with serum creatinine levels less than or equal to 2 mg/dl. Complications occurred in 24 patients but rarely jeopardized the patients' lives or grafts or resulted in permanent disability. The functional capacity of most of the patients was improved by transplantation or was excellent both before and after transplantation. Forty-three transplants were possible through the use of the original or Imuran-modified donor-specific transfusion protocol, so that the lack of compatible donors rarely limited the availability of this therapy. New therapies that might improve graft or patient survival rate cannot reasonably be evaluated in recipients of live donor kidney transplants, because these results are already good. We have estimated that as much as $3.6 million in health care funds could be saved every 2 years at our center if we offered kidney transplants from healthy willing donors to all recipients before instituting dialysis. From our study we conclude that live donor kidney transplantation is an available, highly effective, and cost-efficient form of therapy for patients with end-stage renal disease.