Success rates in kidney transplantation have increased rapidly due to advanced immunosuppressive treatment approaches used in the last two decades . However, there is no significant increase in the number of cadaveric transplantation, while the number of transplant candidates is rapidly increasing. This resulted in an increased need for organs  and prolonged waiting times for transplantation . In many transplantation centers, especially in centers where cross transplantation is frequently performed, both tissue compatibility and blood group compatibility problems have made spousal transplantations be the preferred method of organ transplantation centers [5, 6]. This group, with both tissue compatibility and blood group compatibility problems, has become a preferred alternative, especially due to the high rate of consanguineous marriages in our country. Many centers around the world reported that graft survival rates were equivalent to the transplantations from single haplotype-matched living donor, and that the graft and patient survival rates were better than cadaveric transplantations .
In the present study, the children who received kidneys donated by their parents constituted the majority of transplantations in the living-related donor group. This explains the lower mean age of the recipients and the higher mean age of the donors in this group. Younger age is considered to be a risk factor for higher incidence of transplantation rejection for young people with stronger immunological structure compared to the others . Gjertson et al.  compared spousal and other genetically unrelated transplantations and found that graft survival rates between the two groups were almost the same. Recent publications in the literature have shown that HLA group mismatches do not have much effect on the result of transplantation . However, many single-center studies showed that the graft survival rates were similar in both living-related and spousal donor groups, but there were more HLA mismatches in the spousal donor group . In our study, although the spousal donor group had a significantly higher HLA mismatch compared to the living-related group, it was observed that HLA mismatches did not have a negative effect on the results. In both groups, postoperative serum creatinine levels decreased to stable levels. There was no statistically significant difference although the spousal donor group was generally higher than the living-related group at each different time point after the transplantation.
The results of our study showed that the 3-year patient and graft survival rates were quite high in both groups. The most important factors here are that our center has a serious decision-making mechanism with marginal criteria regarding transplantations, and the stability of our immunosuppressive treatment protocol which includes induction with basiliximab, which is not used in many centers. Similar patient and graft results between spousal and living-related allografts were also reported in Caucasian  and Japanese  subjects. The most important reasons for this similarity between these two groups are considered to be strong immunosuppression, high-quality living grafts, and better compliance with the drug regimen as spouses of similar age and the donor and the recipient lived together .