Open AccessDual kidney transplantation as a strategy to use expanded criteria donors: a systematic review
Author(s) -
Montero Nuria,
RedondoPachón Dolores,
PérezSáez María José,
Crespo Marta,
Cruzado Josep M.,
Pascual Julio
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13157
Subject(s) - medicine , economic shortage , relative risk , transplantation , incidence (geometry) , kidney transplantation , renal function , surgery , confidence interval , linguistics , philosophy , physics , government (linguistics) , optics
Summary The objective of this review was to assess whether dual kidney transplantation ( DKT ) is better than single KT ( SKT ) for optimizing the use of expanded criteria donor kidneys. We did a systematic literature search and meta‐analyses when possible, pooling data for calculating relative risks ( RR ) of major outcomes. Twenty‐five studies met the inclusion criteria. One‐year serum creatinine was better after DKT vs. SKT (mean difference −0.27 [−0.37, −0.17], P < 0.001), with less incidence of acute rejection ( RR 0.66 [0.52, 0.85], P < 0.001) and without differences at five years. Less DGF was seen in DKT ( RR 0.88 [0.76, 1.02], P = 0.09). Mortality at 1 and 3 years was similar after dual or SKT , but mortality at five years was lower after DKT ( RR 0.71 [0.53, 0.94], P = 0.02). One‐year graft loss was similar between dual ( n = 4158) and SKT ( n = 51 800) ( RR 0.97 [0.87, 1.09], P = 0.62). Three‐ and five‐year graft loss was not considered because of high heterogeneity between studies. In conclusion, short‐term graft function and long‐term patient survival are better in recipients receiving DKT vs. SKT . However, these differences are based on few retrospective reports with a relatively low number of cases. Good quality randomized controlled trials are needed to assess whether the investment of two kidneys in one recipient is justified in face of the current organ shortage.