Purpose: To evaluate the results of TRANSPLANTATION from LIVING unRELATED donors (LURD) versus LIVING RELATED donors (LRD) with a long term follow-up of 25-30 years.Materials and Methods: From 1984 to 2015, a total of3716 KIDNEY TRANSPLANTATIONs (411 LRDs and 3305 LURDs) were enrolled to the study. Long-term survival of grafts and patients as well as the association between relation state and patients or grafts surveillance were the outcomes.Results: A total of 3716 live donor KIDNEY transplants (LRD, n=411, LURD, n=3305) were carried out over this period. The mean age of donors was 28 ± 54 years in the LURD group and 34.4 ± 11.7 years in LRD (P<.001), while the mean age of the recipients was 35.6 ± 15.6 years and 27.6 ± 10.1 years for the two groups, respectively. Donor age was the only statistically significant predictor of graft survival rate (hazard ratio=1.021, 95% confidence interval: 1.012-1.031). Between 1984 and 2015, patient survival and graft survival improved significantly also patient survival and graft survival was similar in LURDs compared with LRDs.Conclusion: It seems that the outcome of LURD and LRD is comparable in terms of patient and graft survival. Therefore, transplants from LURDs may be proposed as an acceptable management for patients with end stage renal disease.

Background: While excellent organ quality and ideal transplant conditions eliminate many of the known factors that compromise initial graft function (IGF), slow graft function (SGF), still occurs after LIVING donor KIDNEY TRANSPLANTATION (LDKT). The aim of our current study is determination SGF frequency and its risk factors in LDKT Methods: In this prospective study, between April 2004 and March 2006, data were collected on 340 LDKT, in Baghiyattallah Hospital, Tehran. Recipients were analyzed in two groups based on initial graft function (IGF): Creatinine <3 mg/dl 5 day after TRANSPLANTATION, SGF: Creatinine  ³3 mg/dl 5 day after TRANSPLANTATION with out dialysis in the first week. Donors’ and recipients’ characteristics and recipient lab. data were compared in two groups by chi-square, Mann-whitney & independent samples T-test.Results: The incidence of SGF was 22 (6.2%) and IGF 318 (89.8%), Recipients’ BMI in IGF were 22.1±3.9 and in SGF were 25.3±3.8 (P=0.001 95% Cl 1.097-1.401 OR=1.24). SGF relative frequency in female donors is more than male donors. A multivariate analysis model confirms this significant difference. (P=0.044 95% Cl 1.028-7.971 OR=2.862). SGF relative frequency in PRA (Panel Reactive Antibody) positive recipients are more than negative ones. A multivariate analysis model confirms this significant difference. (P=0.007 95%Cl 1.755-35.280 OR=7.849). Recipients’ age and donors’ BMI are significant in univariate analysis (P=0.002 & P=0.029 respectively) but multivariate analysis model dose not confirm those significance. Serum ca & P & PTH levels don’t have significant difference between IGF & SGF. Using calcium channels blockers have not a protective effect.Conclusions: We conclude that negative PRA and lower recipient BMI have protective effects on SGF. Recipients with female donors have higher chance to develop SGF. We recommend recipients reduce their BMI before TRANSPLANTATION. The male donors are preferred to female ones.

In the September and November 2006 issues of Nature Clinical Practice Nephrology, two articles regarding LIVING unRELATED KIDNEY donor TRANSPLANTATION alluded to the practices in Iran. Having served in the planning, supervision and implementation of various aspects of health care in Iran, including organ TRANSPLANTATION (ANH), and as transplant nephrologists who have actively participated in the care of transplanted patients in Iran (ANH and NG), we feel obligated to elucidate the realities surrounding organ TRANSPLANTATION in Iran. So that unbiased researchers are provided with information to judge for themselves.

During the past decades, the number of altruistic LIVING unRELATED KIDNEY donations has substantially increased in developed countries. However, the altruistic supply of transplantable KIDNEYs has remained much less than the demand. As a result, severe KIDNEY shortage has been associated with increasing number of patient deaths and increasing number of commercial transplants and transplant tourism. Studies have shown that there is still a need for LIVING KIDNEY donation because even all potential braindead donors cannot supply the escalating need for KIDNEYs. The use of LIVING unRELATED KIDNEY donors should be morally and ethically justified and should be compatible with ethical principles. Many experts believe that increasing number of patient deaths and commercial transplants will continue to happen if KIDNEY donation system remains merely altruistic. While some transplant professionals support a paid and regulated system to eliminate KIDNEY shortage, others argue that it will be destructive. Iran has a 20-year experience with a compensated and regulated LIVING unRELATED KIDNEY donation program. This TRANSPLANTATION model was adopted in 1988, and successfully eliminated KIDNEY transplant waiting list by the end of 1999. Currently, more than 50% of patients with end-stage KIDNEY disease in Iran are LIVING with a functioning graft. This Iranian TRANSPLANTATION model has many ethical successes. However, because it has not been well regulated by transplant ethicists, some ethical shortcomings have remained. Unfortunately, due to lack of interest and expertise in health authorities, the number of serious ethical failures is also increasing in this TRANSPLANTATION model.

Background: Delayed graft function (DGF) remains as an important complication in renal TRANSPLANTATION with obvious short-term and possible long-term disadvantages.Objective: To determine the influence of recipient and donor factors on the development of delayed graft factors and their impact on the long-term graft survival.Methods: A total of 237 LIVING KIDNEY recipients were reviewed with regards to recipients and donors’ factors. Delayed graft function was defined as a need for dialysis during the first week after TRANSPLANTATION or failure of serum creatinine to decrease below pretransplant levels within one week regardless of urine out put. Effect of patients’ factors on the development of delayed graft function and its effect on I and 5 years graft survival were studied.Results: Thirty-six out of 237 patient's experienced delayed graft function (15.2%). Incidence of delayed graft function was 10.6% in recipients of LIVING RELATED donors compared to 24.4% in LIVING unRELATED donors (p=0.002). One and 5 years graft survival were 85.5% and 69.5% in patients with immediate graft function and 81.0% and 57.9% in patients with delayed graft function respectively.Conclusion: The only risk factor for delayed graft function in recipients of LIVING KIDNEY transplant as shown by this study was LIVING unRELATED KIDNEY donation. Delayed graft function seems to have no deleterious effect on 1 and 5 years graft survival.

Request for KIDNEY TRANSPLANTATION (K. T. ) is increasing rapidly because of the worldwide pandemic of end-stage renal disease, and the most critical issue is organ shortage. The available deceased donors will not resolve the continuing scarcity of organs. It is now professionally and ethically acknowledged and is vital to pay money to the donors for excluding disincentives of LIVING organ donation. LIVING organ donation should be a vital part of the K. T. Program of any country....

Purpose: To describe the work that the B~kent University Faculty of Medicine has done to increase KIDNEY donors number in Turkey and also to discuss the major effects that donor-organ shortage is currently having worldwide. Materials and Methods: From 1975 through 2003, our tran~plantation team at Hacettepe University Hospital and later at the B~kent University TRANSPLANTATION Center (BUTC) performed 1451 KIDNEY TRANSPLANTATIONs. Cadaver donation and patient and graft survival rates for various groupings of TRANSPLANTATION types were compared. Results: Of all the renal TRANSPLANTATIONs completed in Turkey from 1975 to January 2004, 20% were performed by our team in our center. For the years 1990 through 2003, the 1-, 3-, and 5-year patient survival rates in the first-degree-LIVING-RELATED KIDNEY TRANSPLANTATION group were 96%, 93%, and 91%, respectively, and the corresponding graft survival rates were 93%, 84%, and 81%. In the second-degree LIVING-RELATED group, the 1-, 3-, and 5-year patient survival rates were 94%, 90%, and 87%, respectively, and the corresponding graft survival rates were 93%, 86%, and 84%. For LIVING-unRELATED TRANSPLANTATIONs, the 1-, 3- and 5-year patient survival rates were 93%, 90%, and 83%, respectively, and the corresponding graft survival rates were 83%, 78%, and 76%. In the cadaver-KIDNEY TRANSPLANTATION group, the 1-, 3- and 5-year patient survival rates were 85%, 78%, and 70%, respectively, and the corresponding graft survival rates were 82%, 64%, and 53%. During this same period, the 1-, 3-, and 5-year graft survival rates for our cadaver donors and LIVING donors older than 55 years of age were 80%, 52%, 46% and 88%, 69%, 61%, respectively. Conclusion: Vigorous efforts by our group at B~kent University and by other transplant surgeons across the nation have increased the numbers of TRANSPLANTATIONs performed each year. As well, since the NCC was established in 2001, the number of cadaver-KIDNEY TRANSPLANTATIONs has more than doubled. The initial results with this new nationwide organ-sharing system are promising, and there is every indication that this approach will continue to raise the number of transplant operations performed across Turkey each year.

Background: Renal TRANSPLANTATION is the procedure of choice for most of patients with end-stage renal disease. The graft, however can be procured from either cadaver or LIVING donors.Objective: To compare graft and patient survival among patients who underwent KIDNEY TRANSPLANTATION from cadaver donor vs. LIVING donor.Methods: From April 2002 to February 2010, we performed 138 cadaver KIDNEY TRANSPLANTATIONs. We reviewed and compared one-year graft and patient survival with 138 LIVING KIDNEY TRANSPLANTATIONs.Results: One-year graft and patient survivals in cadaveric groups were 93% and 96%, respectively, and in LIVING groups were 92% and 97%, respectively.Conclusion: There was no significant difference in one-year graft and patient survival between LIVING and cadaver donor KIDNEY TRANSPLANTATION.