Relative impact of donor type on renal allograft survival in black and white recipients

Renal allograft survival of organs from living-related donors (LRDs) is superior to that of organs from cadaveric donors (CAD). Allograft survival rates are lower in black recipients of both CAD and LRD transplants compared with recipients of other races. It is not known whether the superior donor effect of LRD varies between races. We investigated the graft survival outcome of first renal transplants performed in the United States in 1986 and 1989 to determine whether the donor effect differs between black and white recipients. A measurement of "donor type effect" is introduced. There were 7,002 and 7,307 first renal transplants in 1986 and 1989, respectively, for which allograft survival data were available from the United States Renal Data Systems. Both black and white recipients showed a greater than 50% reduction in the risk of allograft loss at all the points studied up to 5 years posttransplant when LRD was chosen over CAD transplantation. A measurement of donor type effect indicates that graft loss is reduced by 7 to 21 percentage points at 1 and 5 years posttransplant. The donor type effect is proportionally equal in both races. Therefore, kidney donation from living relatives as a first transplant should be encouraged for all medically suitable end-stage renal disease patients as a means of improving outcome and reducing CAD transplantation waiting time for patients in whom LRD transplants cannot be performed.