Dual Kidneys from Marginal Adult Donors as a Source For Cadaveric Renal Transplantation in the United States

Abstract

Abstract. The current organ shortage has led to the utilization of double kidney transplants from marginal adult donors, but outcomes data are limited. The United Network for Organ Sharing registry database was used to compare the outcomes of 403 dual adult kidney transplantations (DKT) and 11,033 single kidney transplantations (SKT) from 1997 to 2000. Graft and patient survival and the effect of multiple risk factors were evaluated. It was found that DKT patients were older, less sensitized, and received grafts from older, more mismatched donors with longer cold ischemia times. There was also a greater percentage of donors with a history of diabetes or hypertension and African-American recipients and donors in the DKT group. Graft survival was inferior in the DKT group, with a 7% lower graft survival rate at 1 yr. There was a higher incidence of primary nonfunction in the DKT group, although the incidence of delayed graft function, early rejection treatment, and graft thrombosis did not differ. Multivariate analysis was used to identify African-American recipient ethnicity and retransplant as risk factors for graft loss. Graft survival was comparable in DKT and SKT with donors over 55 yr of age. DKT resulted in inferior graft outcomes compared with SKT. When compared with SKT with donors over 55 yr of age, DKT resulted in similar graft outcomes. These otherwise discarded kidneys should be cautiously considered as a source of marginal donors.Kidney transplantation has become the treatment of choice for end-stage renal disease patients (1). The demand for kidney transplants has increased dramatically in the last several years. This is evidenced by the current waiting list, which has increased to more than 50,000 patients in the United States. The annual death rate for patients on the wait list is 6.3% (2). Despite the increased demand, the number of cadaver donors has remained stable and is clearly insufficient to keep pace with the dramatically increasing demand. This has resulted in prolonged waiting times, with increased dialysis-related morbidity and mortality (1). These factors have made patients less acceptable candidates for transplantation and ultimately affected patient and graft survival once transplantation has been achieved (3).The rapid increase in the number of patients awaiting transplantation has led many transplant centers to consider accepting older kidney donors with co-morbidities (4). Despite this, the number of organs retrieved but not transplanted has increased from 400 in 1990 to 1300 in 2000. Multiple innovative techniques have evolved in an attempt to utilize these wasted organs (5). One of these involves the utilization of double kidney transplants from extremely young or old donors to compensate for marginal allograft function (3). Recently, the University of Maryland and Stanford University have routinely accepted adult kidneys that have been discarded by other local centers and transplanted both kidneys into a single recipient (6). This practice has been adopted by multiple centers i...

Dual Kidney Transplant: A Single-Center Experience and Review of the Literature

“…14 Andres and associates 17 and UNOS criteria. 18 However, he did not find any improvement in 12-month eGFR of DKT compared with allocation based on donor eGFR. The only consensus found among centers is the basic of conditions for ECD, which are generally accepted as the starting point for further decision-making.…”

“…These studies found lower or similar DGF rates after a DKT. 12,17,18 Graft survival after a DKT compared with an SKT at 5 years (69% vs 61%) and 8 years (69.7% vs 59.4%) has been reported as comparable. 28,29 Despite good DKT outcomes, decision-making remains the main dispute.…”

“…Andres and 2000 P, SC 21 15 ± 5 Age 60 to 74 y with 100% (12) 95% (12) PNF, AR were comparable with SKT, associates 17 GS 15% to 50%, age IF was significantly higher comparable ≥ 75 with GS < 50% with SKT Bunnapradist 2003 R, MC 403 36 Kidneys not suitable ---62% (36) PNF was higher, DGF, AR was and associates 18 for SKT according UNOS comparable with SKT, and overall graft survival was lower, apart from DKT with donors over 55 y of age when graft survival was comparable with SKT. 7 However, subsequent analyses of these patients reveals that the recipients of DKTs from donors 54 to 60 years old had low serum creatinine levels up to 2 years after transplant and that may mean that these kidneys could have been used for an SKT.…”

“…17 In retrospective study of the UNOS data, graft with glomerulosclerosis over 20% had a similar 1-year graft survival in SKT and DKT patients. 18 A composite score, including clinical, perioperative, and histologic parameters, also is used for DKT selection. In a study by Dietl and associates, 19 scores based on donor age, serum creatinine, kidney weight, and degree of glomerulosclerosis was used to allocate kidneys for single or dual transplant.…”

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“…In the United States, patients waiting for kidney transplant now number 50000 with an annual death rate of 6.3%. 1 To increase the number of organs available for transplant, the use of kidneys from donors from age extremes (pediatric or elderly) has been suggested. In late 2003, the United Network for Organ Sharing (UNOS) implemented the use of kidneys from extended criteria donors (ECDs).…”