Allogeneic hematopoietic cell transplantation (HCT) from human leukocyte antigen (HLA) matched related donor (MRD) and matched unrelated donors (MUD) produces similar survival for patients with acute myelogenous leukemia. Whether these results can be extended to patients with myelodysplastic syndromes (MDS) is unknown. Therefore, a disease-specific analysis of post-HCT outcomes for MDS was performed. Outcomes of 701 adult MDS patients who underwent HCT between 2002 and 2006 were analyzed (MRD, n=176; 8/8 HLA-A, B, C, DRB1 allele matched MUD, n=413; 7/8 MUD, n=112). Median age was 53 years (range, 22-78). Thirty-one percent had Karnofsky performance scores <90% at HCT. In multivariate analyses, MRD HCT recipients had similar disease free survival (DFS) and survival rates compared to 8/8 MUD HCT recipients (relative risk [RR] 1.13 (95% confidence intervals [CI] 0.91-1.42) and 1.24 (95% CI 0.98-1.56), respectively), and both MRD and 8/8 MUD had superior DFS (RR 1.47 (95% CI 1.10-1.96) and 1.29 (95% CI 1.00-1.66), respectively) and survival (RR 1.62 (95% CI 1.21-2.17) and 1.30 (95% CI 1.01-1.68), respectively) compared to 7/8 MUD HCT recipients. In patients with MDS, MRD remains the best stem cell source followed by 8/8 MUD. Transplantation from 7/8 MUD is associated with significantly poorer outcomes.