Comparative Outcomes of Spousal and Living-related Donor Renal Transplantation under Tacrolimus- and Mycophenolate-based Triple Immunosuppression: A Retrospective Analysis from a Single Center in South India

Background: This study compares postrenal transplantation outcomes between live-related donor (LRD) and spousal donor (SD) groups, maintained on tacrolimus- and mycophenolate-based triple immunosuppression. Materials and Methods: A retrospective analysis of 278 patients (LRD: 216 and SD: 62) was conducted to evaluate short- and long-term clinical outcomes at a single center in South India. Results: SD donors were predominantly female (91.9% vs. 78.2%) and younger (34.4 ± 8.2 years vs. 46.43 ± 7.2 years), while SD recipients were older (38.47 ± 8.1 years vs. 28.15 ± 6.7 years). The SD group had a higher human leukocyte antigen AB and DR mismatch ( P < 0.001). All the recipients in the study received maintenance immunosuppression with corticosteroid, tacrolimus, and mycophenolate, and none of the patients in the study received induction therapy. Overall acute rejection rates were 12.5% at the end of 1 year of transplantation, showing no significant differences between the groups ( P = 0.16). Patient, graft, and death-censored graft survival outcomes were comparable between the SD and LRD groups ( P = 0.14, P = 0.07, and P = 0.063, respectively). Although the differences in survival rates between SD and LRD were comparable, there was a trend toward higher survival rates in the LRD group than in the SD group. Conclusion: This study reinforces that spousal donor renal transplantation without induction therapy demonstrates comparable outcomes to living-related donor transplantation under triple immunosuppression. Further research is needed to evaluate the potential role of induction therapy in spousal donation, particularly its impact on long-term graft survival and rejection prevention without increasing infection risks.