Dual kidney transplantation offers a safe and effective way to use kidneys from deceased donors older than 70 years

Abstract

Purpose: Dual kidney transplantation (DKT) offers a way to extend the use of kidneys from expanded criteria donors (ECDs). Here, we compared the outcomes of DKT with those of single kidney transplantation from standard criteria donors (SCDs) and ECDs. Methods: In 2014, we began performing DKT using both kidneys from deceased donors greater than 70 years of age with one of two risk factors: serum creatinine (sCr) level over 3.0 mg/dl or eGFR under 30 ml/min. By 2017, we had performed 15 DKTs. We compared the outcomes of the 15 DKT recipients with those of 124 patients who received a kidney from an SCD and 80 patients who received a kidney from an ECD. Results: Compared with ECDs and SCDs, DKT donors were older, had a higher diabetes burden, and a higher sCr level (p < 0.01, < 0.01, and 0.03, respectively). DKT recipients were also older and had a higher diabetes burden than recipients of kidneys from ECDs and SCDs (p < 0.01, both). DKT recipients had a lower nadir sCr and shorter duration to nadir sCr than single ECD KT recipients (p < 0.01and 0.04, respectively). Conclusions: The survival rates of DKT grafts were compatible with those of single KT grafts. Therefore, DKT may be considered a suitable an option to expand the donor pool.

Degree of Glomerulosclerosis in Procurement Kidney Biopsies from Marginal Donor Kidneys and Their Implications in Predicting Graft Outcomes

“…Thus, instead of discarding >85% KDPI kidneys with >10% GS due to a higher risk of allograft loss, future studies are needed to identify techniques and strategies to improve the use and outcome of these "marginal" transplantable kidneys safely. Certain strategies are already being used, such as dual transplantation (both kidneys from one donor into the same recipient) [38,[48][49][50][51][52] or creation of a protocol designed to timely identify and match suitable patient characteristics with these "marginal" kidneys (e.g., balancing the number of viable nephrons supplied within the graft versus the metabolic demand of the recipient [32]). For example, a >85% KDPI kidney with >10% GS recovered from a female donor with a low BMI may not be the best option for a male candidate with a BMI>35 kg/m 2 [53]; further studies are needed to identify other patient and donor characteristics that would yield optimal outcomes.…”

Staggered Dual Kidney Transplantation

“…1 One technique is the use of 2 extended criteria grafts in 1 recipient, a dual kidney transplant, to complement the use of marginal kidneys. 1–2…”

“…To address rising numbers of patients on kidney transplant waiting lists, there is increased usage of extended criteria donor kidneys (ECDs). 1 One technique is the use of 2 extended criteria grafts in 1 recipient, a dual kidney transplant, to complement the use of marginal kidneys. [1][2] The first dual kidney transplantation was reported in 1996 with several subsequent publications on this technique.…”

“…1 One technique is the use of 2 extended criteria grafts in 1 recipient, a dual kidney transplant, to complement the use of marginal kidneys. [1][2] The first dual kidney transplantation was reported in 1996 with several subsequent publications on this technique. [1][2] The theoretical justification underlying this method is that the provision of a second graft doubles the nephron mass, and thus increases the potential functional capacity of the transplant.…”

“…[1][2] The first dual kidney transplantation was reported in 1996 with several subsequent publications on this technique. [1][2] The theoretical justification underlying this method is that the provision of a second graft doubles the nephron mass, and thus increases the potential functional capacity of the transplant. However, that advantage is counterbalanced by the need for a surgical procedure of increased magnitude and potentially increased peri-operative morbidity.…”