Expanded Criteria Donor Kidney Transplantation: Comparative Outcome Evaluation Between Single Versus Double Kidney Transplantation at 8 Years: A Single Center Experience

Paolis, Paolo De; Colonnelli, Roberto; Favarò, Antonio; Salem, Fadi; Vignally, Pascal; Carriero, C; Iappelli, M; Giulio, Salvatore Di

doi:10.1016/j.transproceed.2016.02.007

Cited by 11 publications

(11 citation statements)

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“…It can be explained by that DKT can supply sufficient number of nephron and, even if some fraction of nephrons were injured, enough number of nephrons is preserved to facilitate primary function. Recently, many studies have reported that graft survival and graft function are not significantly difference between single KT and DKT [5][6][7][8][9][10][13][14][15][16][17][18][19][20]. However, the donor selection criteria for DKT among these studies varies.…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Park

et al. 2020

BMC Nephrol

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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.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, to reduce the graft discard rate it is necessary to use kidneys from older donors. Numerous studies have reported successful outcomes after DKT from donors older than 70 [7,14,[16][17][18][19][20]. Thus, we selected 70 as the donor age threshold in our study.…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Park

et al. 2020

BMC Nephrol

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“…Наличие этой причины ТМА у части реципиентов, по-видимому, служит неизбежным следствием использования доноров с «расширенными критериями» (оправданным в условиях жесткого дефицита донорских органов во всем мире), а также противоречивой предсказательной ценности в отношении дальнейшей функции трансплантатов результатов «нулевых» биопсий [23,24]. В нашей практике показатели почечной функции у доноров с выявленной впоследствии (уже в организме реципиента) ренальной ТМА во всех случаях не выходили за рамки допустимых для осуществления изъятия почек.…”

Section: Discussionunclassified

Thrombotic microangiopathy after kidney transplantation: causes, clinical specifics and outcomes

et al. 2020

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Background: Thrombotic microangiopathy (TMA) is a clinical and morphological phenomenon characterized by specific microvascular injury, microangiopathic hemolytic anemia, and damage of various target organs. TMA after kidney transplantation (post-renal transplant TMA) is a serious complication affecting the recipient and graft survival.Aim: To analyze the timing, causes, specifics of the clinical course and outcomes of TMA in renal transplant recipients.Materials and methods: This one-center study was based on a comprehensive examination and follow-up of 697 patients who had undergone 728 kidney transplantations (KT) from deceased donors in 2003–2019. Post-transplant TMA of the renal graft was confirmed morphologically in all cases.Results: We identified 32 episodes of post-transplant TMA in 32 patients; thus, the incidence of TMA was 4.4%. All cases developed after KT de novo; no recurrent TMA was observed. TMA was systemic in 37.5% and locally renal in 62.5% of the patients. The median time to the development of post-transplant TMA was 0.55 (range, 0.1 to 51.6) months. The patients with TMA did not differ from those without by gender, age, body mass index, underlying disorders, type and duration of dialysis before KT, protocols of immunosuppressive therapy, incidence of surgical, urological, infectious, cardiovascular and oncological complications. The patients with TMA were significantly more likely to have graft rejection (25.0% vs 11.2%, p = 0.035) and a never-functioning transplant (28.1% vs 4.9%, p < 0.001). The presence of TMA negatively affected the transplantation outcomes. The cumulative 1-year graft survival in the patients without and with TMA was 91% and 44%, respectively, whereas their 5-year survival rates were 68% and 25% (p < 0.001). The leading causes of TMA were: donor pathology (31.2%), antibody-mediated rejection (28.1%), and cyclosporine/ tacrolimus nephrotoxicity (21.9%); the proportion of other causes was 18.8%. A combination of TMA etiological factors was identified in 68.7% of the recipients. The recipients with of calcineurin inhibitors nephrotoxicity had a more favorable prognosis compared to those with other causes of TMA.Conclusion: Post-renal transplant TMA is an infrequent but serious complication that worsens the graft survival and often is life-threatening for recipients. In most cases, TMA develops in the early post-operative period; however, it can occur any time thereafter. To improve the outcome of TMA, early diagnosis is necessary based on clinical suspicion and a prompt biopsy of the renal graft with suspected TMA. Treatment should be started quickly with consideration of the cause of the complication.

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“…Due to the burgeoning crisis between organ supply and demand, national initiatives such as the Organ Donor Breakthrough Collaborative were created in order to expand the size of the DD pool 14,15 . These efforts resulted in an upturn in the number of “marginal” DDs (MDDs) such as expanded criteria donors (ECDs), 16–21 donation after cardio‐circulatory death (DCD) donors, 22–24 standard criteria donors (SCDs) with prolonged warm or cold ischemia times (CIT), 25–28 acute kidney injury donors, 29–34 and dual kidney transplants (DKT) from donors at the extremes of age 35–145 . These latter references cited represent the majority of the world literature to date on DKT from adult MDDs and are listed in chronological order by year of publication.…”

Section: Introductionmentioning

confidence: 99%

“…DDs with marginal renal functional capacity represent a large proportion of potential kidneys doomed to discard or non‐recovery 7,10,11,33,110,148–175 . One approach to offset this dilemma has been the greater application of DKT from adult MDDs 35–145 . There have been several excellent recent reviews focusing on various aspects of DKT 72,118,127,129,130,138,142 .…”

Section: Introductionmentioning

confidence: 99%

Dual kidney transplants from adult marginal donors: Review and perspective

Stratta

Harriman

Gurram

et al. 2022

Clinical Transplantation

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The practice of dual kidney transplantation (DKT) from adult marginal deceased donors (MDDs) dates back to the mid-1990s with initial pioneering experiences reported by the Stanford and Maryland groups, at which time the primary indication was estimated insufficient nephron mass from older donors. Multiple subsequent studies of short and long-term success have been reported focusing on three major aspects of DKT: Identifying appropriate selection criteria and developing scoring systems based on pre-and post-donation factors; refining technical aspects; and analyzing mid-term outcomes. The number of adult DKTs performed in the United States has declined in the past decade and only about 60 are performed annually. For adult deceased donor kidneys meeting double allocation criteria, > 60% are ultimately not transplanted. Deceased donors with limited renal functional capacity represent a large proportion of potential kidneys doomed to either discard or non-recovery. However, DKT may reduce organ discard and optimize the use of kidneys from MDDs. In an attempt to promote utilization of MDD kidneys, the United Network for Organ Sharing introduced new allocation guidelines pursuant to DKT in 2019. The purpose of this review is to chronicle the history of DKT and identify opportunities to improve utilization of MDD kidneys through DKT. K E Y W O R D Sdual kidney transplants, index, kidney discard, kidney donor profile marginal deceased donors, nephron mass INTRODUCTIONFor patients with end stage renal disease (ESRD), kidney transplantation is associated with extended life expectancy, improved quality of life, and has proven to be cost-effective long-term compared to any type of dialysis. 1-6 As of August 2021, the United Network for Organ Sharing (UNOS) national waiting list for solid organ transplantation had nearly 107 000 total candidates, including > 90 000 patients (84.6%) awaiting kidney transplantation. 7 Unfortunately, only 22 817 kidney

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Expanded Criteria Donor Kidney Transplantation: Comparative Outcome Evaluation Between Single Versus Double Kidney Transplantation at 8 Years: A Single Center Experience

Cited by 11 publications

References 11 publications

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

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

Thrombotic microangiopathy after kidney transplantation: causes, clinical specifics and outcomes

Dual kidney transplants from adult marginal donors: Review and perspective

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