Critical comparison of renal transplant survival between recipients of live related donor and cadaver organs.

Survival statistics of 163 cadaver and 60 live related donor renal transplants from a single center were analyzed. Survival rates at one, two and three years for 38 first cadaver transplants matched for a haplotype and 34 first live related donor haplotype matched kidneys were virtually the same. In addition, nine, four antigen matched cadaver transplants had a comparable survival rate at one, two and three years to the larger group of 25 HL-A identical live related donor kidneys. When poor risk cadaver recipients were excluded from the entire cadaver group, the graft survival rate approached that of the live related group at one year but declined more rapidly at two and three years than did the live related donor group. Thus, cadaver renal transplantation in this series appears to be an alternative to comparably matched live related donor transplants. An increased effort should be made to identify and use brain death cadaver donors for transplantation. As more donors become available and national sharing systems are improved, a strong case can be made to avoid the use of live related donor kidneys, except in instances of a perfect match.