Spousal Renal Transplantation—Single-Center Experience S. Ossareh and A.J. Ghods E VIDENCE of high rates of survival of renal transplants from spousal donors has been reported from different centers, in spite of poor HLA matching. 1–3 Kidney donation by spouses has been ethically approved in many countries, but is prohibited by law in others. 4 In Iran kidney trans- plantation (Tx) from spousal donors has been a part of living-unrelated kidney Tx programs. The objectives of this study were to evaluate the patient and graft survival rates in spousal Tx, to compare these rates with the corresponding rates in living-related, living- unrelated, and parental donor Tx in our center, and to compare the results of wife to husband (W to H) and husband to wife (H to W) kidney Tx. PATIENTS AND METHODS Between April 1986 and April 1998, 1160 renal Txs were performed in our center. Of these, 21 Txs were from spousal donors. Fifteen recipients were male (W to H) and 6 female (H to W). The mean age of patients was 38 years, ranging from 26 to 50 years. The mean follow up period was 42.5 months, with a range of 6 to 117 months. The immunosuppressive therapy consisted of cyclosporine, aza- thioprine and prednisolone in almost all cases. Overall patient and graft survival rates, patient and graft survival in W to H and H to W, and the causes of graft loss were studied. Patient and graft survival rates were compared with the corre- sponding rates in living-related and living-unrelated Txs (5) and parental donor Tx (6) in our center. Graft loss was defined as patient death or return to chronic dialysis. Chronic rejection was diagnosed on the basis of clinical findings and renal biopsy results. Fisher’s exact test was used for the comparison of results. RESULTS In a mean follow-up period of 42.5 months in 21 spousal renal Txs, patient and graft survival rates were 94.4%, 93.3%, and 88.8%, 80% at 1 and 3 years, respectively. The corresponding rates were 94%, 92% and 85%, 76% in 620 patients transplanted in our center, 5 95%, 94% and 83%, 76% in 353 living-related donor Txs, and 95%, 92% and 82%, 70% in 267 living-unrelated donor Txs in the same study. 5 There was no statistically significant difference be- tween the patient and graft survival rates of spousal donor Txs and the corresponding overall, living-related, and liv- ing-unrelated donor Tx survival rates at our center. Also the graft survival rates of 134 parental donor Txs carried out in our center, which were 88% and 69% at 1 and 3 years respectively, 6 had no statistically significant difference with our spousal donor Tx results. The graft survival rates at 1 and 3 years were 100% and 90% in W to H Tx and 66.6% and 50% in H to W Tx, respectively. In spite of the apparently different rates, there was no statistically significant difference between them. The causes of graft loss were chronic rejection in four cases, renal vein thrombosis in one case, primary graft nonfunc- tion with septic shock and patient death in one case, and patient death due to myocardial infarction with a function- ing graft in one case. DISCUSSION Spousal donation of kidney grafts is an ethically approved part of kidney Tx program in many centers 1– 4,7 and has shown unexpectedly high rates of graft survival despite poor HLA matching. 1–3 In this study we showed the same good results with no difference in graft survival rates with our overall living donor, living-unrelated, living-related, and parental donor Txs. Kidney donation was more frequent from wives to husbands in our center, similar to studies from other centers. 1,3 There was no significant difference between graft survival rates in wife to husband and husband to wife kidney Tx in accordance with previous patient studies. 1 Our patient numbers numbers, however, were too small for statistical analysis and to draw firm conclusions. We conclude that spousal renal donors are acceptable sources for renal Tx. The results are comparable to other living donor Txs but more cases are necessary for statistical analysis and to draw a firm conclusion. REFERENCES 1. Terasaki PI, Cecka JM, Gjertson DW, et al: N Engl J Med 333:333, 1995 2. Haberal M, Gu ¨lay H, Tokyay R, et al: World J Surg 16:1183, 1992 3. Velidedeoglu E, Bilgin N, Haberal M: Transplant Proc 25: 2185, 1993 4. Soulillou JP: N Engl J Med 333:379, 1995 5. Ghods AJ, Prooshani F, Ghahramanin, et al: In Cugh KS (ed): Asian Nephrology. Oxford: Oxford University Press; 1994, p 701 6. Ghods AJ, Khosravani P: Transplant Proc 29:2767, 1997 7. Velidedeoglu E, Tokyay R, C ¸ uhadaroglu S, et al: Transplant Proc 24:1894, 1992 From Hashemi Nejad Hospital, Tehran, Iran. Address reprint requests to Shahrzad Ossareh, Hashemi Nejat Hospital, Vanak Square, Tehran, Iran. © 1999 by Elsevier Science Inc. 0041-1345/99/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S0041-1345(99)00743-5 Transplantation Proceedings, 31, 3121 (1999) 3121