To compare patient and graft survival of kidney transplant recipients who received a kidney from a living-related donor (LRD) or living-unrelated donor (LUD).
Adult patients in the ERA-EDTA Registry who received their first kidney transplant in 1998-2017 were included. Ten-year patient and graft survival were compared between LRD and LUD transplants using Cox regression analysis.
In total, 14,370 patients received a kidney from a living donor. Of those, 9,212 (64.1%) grafts were from a LRD, 5,063 (35.2%) from a LUD and for 95 (0.7%) the donor type was unknown. Unadjusted five-year risks of death and graft failure (including death as event) were lower for LRD transplants than for LUD grafts: 4.2% (95% confidence interval [CI]: 3.7-4.6) and 10.8% (95%CI: 10.1-11.5) versus 6.5% (95%CI: 5.7-7.4) and 12.2% (95%CI: 11.2-13.3), respectively. However, after adjusting for potential confounders, associations disappeared with hazard ratios of 0.99 (95%CI: 0.87-1.13) for patient survival and 1.03 (95%CI: 0.94-1.14) for graft survival. Unadjusted risk of death-censored graft failure was similar, but after adjustment it was higher for LUD transplants (1.19; 95%CI: 1.04-1.35).
Patient and graft survival of LRD and LUD kidney transplant recipients was similar, whereas death-censored graft failure was higher in LUD. These findings confirm the importance of both living kidney donor types.

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