Premium
Dual kidney transplants from adult marginal donors successfully expand the limited deceased donor organ pool
Author(s) -
Stratta Robert J.,
Farney Alan C.,
Orlando Giuseppe,
Farooq Umar,
AlShraideh Yousef,
Palanisamy Amudha,
ReevesDaniel Amber,
Doares William,
Kaczmorski Scott,
Gautreaux Michael D.,
Iskandar Samy S.,
Hairston Gloria,
Brim Elizabeth,
Mangus Margaret,
ElHennawy Hany,
Khan Muhammad,
Rogers Jeffrey
Publication year - 2016
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12697
Subject(s) - medicine , dialysis , renal function , kidney , retrospective cohort study , surgery , organ donation , creatinine , single center , incidence (geometry) , transplantation , kidney transplantation , urology , physics , optics
Background The need to expand the organ donor pool remains a formidable challenge in kidney transplantation ( KT ). The use of expanded criteria donors ( ECD s) represents one approach, but kidney discard rates are high because of concerns regarding overall quality. Dual KT ( DKT ) may reduce organ discard and optimize the use of kidneys from marginal donors. Study design We conducted a single‐center retrospective review of outcomes in adult recipients of DKT s from adult marginal deceased donors ( DD ) defined by limited renal functional capacity. If the calculated creatinine clearance in an adult DD was <65 mL/min, then the kidneys were transplanted as a DKT . Results Over 11.5 yr, 72 DKTS were performed including 45 from ECD s, 17 from donation after cardiac death ( DCD ) donors, and 10 from standard criteria donors ( SCD ). Mean adult DD and recipient ages were both 60 yr, including 29 DD s and 26 recipients ≥65 yr of age. Mean pre‐ DKT waiting and dialysis vintage times were 12 months and 25 months, respectively. Actual patient and graft survival rates were 84.7% and 70.8%, respectively, with a mean follow‐up of 58 months. One yr and death‐censored graft survival rates were 90% and 80%, respectively. Outcomes did not differ by DD category, recipient age, or presence of delayed graft function ( DGF ). Eleven patients died at a mean of 32 months post‐ DKT (eight with functioning grafts) and 13 other patients experienced graft losses at a mean of 33 months. The incidence of DGF was 25%; there were two cases (2.8%) of primary non‐function. Mean length of initial hospital stay was 7.2 d. Mean serum creatinine and glomerular filtration rate levels at 12 and 24 months were 1.5 and 53 and 1.5 mg/dL and 51 mL/min/1.73 m 2 , respectively. DKT graft survival and function were superior to concurrent single ECD and similar to concurrent SCD KT s. Two patients underwent successful kidney retransplantation, so the dialysis‐free rate in surviving patients was 87%. The proportion of total renal function transplanted from adult DD to DKT recipients was 77% compared to 56% for patients receiving single KT s. Conclusions Dual kidney transplantation using kidneys from adult marginal DD s that otherwise might be discarded offer a viable option to counteract the growing shortage of acceptable single kidneys. Excellent medium‐term outcomes can be achieved and waiting times can be reduced in a predominantly older recipient population.