Living kidney donation in Brazil, 2010-2023: a descriptive time-series analysis.

INTRODUCTION: Chronic kidney disease imposes a high clinical and economic burden on the Brazilian Unified Health System, and kidney transplantation represents one of the best therapeutic choices for selected patients. OBJECTIVE: To describe trends in living-donor (LD) kidney transplantation in Brazil (2010-2023), analyzing the donor-recipient relationship and the operational stock-to-annual production ratio on the waiting list, as well as to compare hospital indicators and estimated patient and graft survival between LD and deceased-donor (DD) kidney transplants. METHODS: This descriptive time-series study used aggregated, publicly available data. RESULTS: The waiting list increased by 15% (from 33,253 to 38,258), and the total number of transplants rose by 29% (from 4,656 to 6,047). Data showed an increase in deceased-donor transplants (from 3,001 to 5,189) and a decrease in LD transplants (from 1,655 to 858), with the LD share declining from 35.55% to 14.19% and the per-million-population rate falling from 8.8 to 4.2. Among LD, there was a relative decrease in related donors (from 82.80% to 71.21%), a relative increase in unrelated spouse donors (from 10.57% to 18.65%), and a relative increase in other unrelated donors (from 6.64% to 10.14%). In descriptive comparisons, LD transplantation showed higher published patient and graft survival estimates and more favorable hospital indicators, including lower in-hospital mortality, shorter length of stay, and lower mean hospital admission authorization values. CONCLUSION: The findings suggest the relevance of integrated strategies to sustain deceased-donor procurement and strengthen living-donor kidney transplantation. However, comparisons between donor types were descriptive and should not be interpreted as causal.