Dual kidney transplant techniques: A systematic review

Abstract

The three techniques have equivalent delayed graft function as well as patient and graft survival rates. This is an encouraging result as it means that the surgeon can choose to use the technique which is most appropriate for their own skills and for the patient.

Renal Transplants from Older Deceased Donors: Use of Preimplantation Biopsy and Differential Allocation to Dual or Single Kidney Transplant according to Histological Score Has No Advantages over Allocation to Single Kidney Transplant by Simple Clinical Indication

“…As described by others [ 18 , 31 ] we showed that DKT recipients who lost one graft maintained a satisfactory renal function in all the available follow-up (up to 76 months in a patient), despite a very bad histological score of remaining organ. This indicates that at least a fraction of grafts used for DKT might perform quite well as SKT in a double number of recipients.…”

“…day 11 and 4 mg/day after 3 months); a minority of patients (less than 10%), enrolled in clinical studies, might have been induced with Basiliximab and/or treated with Tacrolimus, Everolimus, or Sirolimus as alternatives; Azathioprine was also substituted for Mycophenolate in gastrointestinal intolerant patients. Posttransplant heparin anticoagulation was started in 2011 only in DKT, and after that a higher than usual graft vein thrombosis was observed in this type of transplant, as described also by others [ 18 ].…”

Vascular Reconstructions in Kidney Transplantation

“…A recent review [16] compared the three techniques of bilateral placement, unilateral placement with separate anastomoses, and unilateral placement with patch anastomoses, in dual kidney transplantation, and they reported a similar graft and patient survival among the three groups.…”

“…Dual kidney transplantation (DKT) of marginal kidneys could offer transplant candidates very satisfactory kidney transplantation in terms of renal function. However, DKT might be considered a major surgical procedure and, in older recipients, has a potentially greater risk of surgical complications compared with single kidney transplantation [12,13,[15][16][17]. While different surgical techniques have been described, including the positioning of one kidney for each side extraperitoneally and the positioning of both kidneys intaperitoneally, most transplant centers, to reduce the intraoperative time and the rate of surgical complications, positioned both grafts on the same side [12,15,16].…”

“…However, in order to reduce the number of anastomoses and the operative time, some transplant centers tried to develop new surgical techniques in dual kidney transplantation. By employing techniques used to conjoin organ vasculature ex vivo, the number of in situ anastomoses is reduced, thereby minimizing operative ischemic time and potential for complications associated with extensive vascular dissection [13,16,[18][19][20]. Moreover, these techniques could be used even in those patients with a moderate-to-severe atherosclerosis of the iliac vessels, which is usually a contraindication for dual kidney transplantation [18].…”