Comparing Outcomes of Spousal Kidney Transplants With Living-Related Donors in Dsa-Positive Recipients: Is the Risk Increased in Husband-to-Wife Donation?

Introduction: 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 (DSA) 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. Methods: This study was conducted in our Nephrology and Transplantation department. It involved 59 spousal donors and 72 living-related donors with donor-specific antibodies who were older than >18 years of age. We evaluated the consecutive patients who had kidney transplantation between 2010-2020. Results: We analyzed data from 59 SDT with 72 living-related donor transplants (LRDT) 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 three patients, comprising two in the LRDT group and one in the W-to-H group. Conclusion: In conclusion, 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 appears to be safe in the long term.