Outcome of en Bloc and Single Kidney Transplantation From Very Young Cadaveric Donors1,2,3,4,5,6

Satterthwaite, Roger; Aswad, S.; Sunga, Victor; Shidban, Hamid; Méndez, R.; Bogaard, T.; Asai, P.; Khetan, U.; Magpayo, Marisa; Mendez, Robert

doi:10.1097/00007890-199705270-00006

Cited by 113 publications

(87 citation statements)

References 33 publications

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“…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).…”

mentioning

confidence: 99%

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

Bunnapradist¹,

Gritsch²,

Peng³

et al. 2003

Journal of the American Society of Nephrology

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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...

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mentioning

confidence: 99%

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

Bunnapradist¹,

Gritsch²,

Peng³

et al. 2003

Journal of the American Society of Nephrology

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“…There were no delayed graft functions in our series. In their series of 22 patients, Satterthwaite et al 1 reported that 14% never functioned, and 23% had delayed graft function.…”

Section: Discussionmentioning

confidence: 96%

“…In their series, Bretan et al 5 documented one graft loss (2.5%) of venous thrombosis due to hypercoagulable state. In their series of 22 en bloc kidney transplants, Satterthwaite et al 1 reported one venous thrombosis (4.5%) and two arterial thrombosis (9%), and all three grafts were lost. In their series of 45 patients, Nghiem et al 7 had six cases of venous thrombosis (13%), and all were lost.…”

Section: Discussionmentioning

confidence: 98%

“…One-and five-year graft survival for pediatric en bloc kidneys has been reported as 82% and 70%, respectively, by Satterthwaite et al 1 Gruessner et al 2 reviewed 17 years' experience at the University of Minnesota, and demonstrated that kidneys of the same donor age but transplanted en bloc had significantly higher graft survival rates than single kidneys of the same donor age, 78% at one year and 48.6% at 10 years, compared to only 61% at one year and 34% at 10 years. Nghiem et al 3 reported that when the en bloc and the non en bloc primary cadaveric groups were compared, no significant difference in the five-year graft survival rate was observed (68.8% and 65.3%, respectively), suggesting that infant kidneys transplanted en bloc had fairly long-term graft survival.…”

Section: Discussionmentioning

confidence: 99%

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Single Center Experience of En Bloc Kidney Transplantation and Review of Literature

et al. 1999

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As the number of end-stage renal disease patients requiring transplant was steadily increasing, and the shortage of organs was becoming more severe, we began using cadaveric pediatric kidneys in 1989. When the age of the donor was less than three years, we used both kidneys together (en bloc) for one recipient. Materials and MethodsFrom 1989 to 1997, we performed seven en bloc transplants from cadaveric donors aged between seven months and three years. Five of the seven patients were adults, and two were pediatric recipients. It was the second transplant in the first three recipients. The donor aorta and vena cava were sewn at their proximal ends. The distal end of the aorta was anastomosed to the external iliac artery and the vena cava to the external iliac vein. The ureters were sutured to make a single opening and anastomosed to the bladder as extravesical ureteroneocystostomy ( Figure 1).All the patients except Case numbers 3 and 7 received quadruple sequential therapy ALG or ATG, prednisone, cyclosporin or FK506 and Imuran or Mycophenolate Mofetil (MMF). The monoclonal antibody OKT3 was used for steroid-resistant rejection. FK506 was used as first-line treatment, or as rescue therapy in resistant rejection. Of late, MMF is being used as an initial immunosuppression. ResultsCase number 1 received an en bloc kidney transplant in 1989, and was given anti-thymocyte globulin (ATG) as induction. The patient developed two episodes of biopsy-proven rejection at 21 days and at two months, and was given OKT3 for 10 days. The kidneys never functioned and transplant nephrectomy was performed on the 68th day. The donor was a three-year-old whose renal function at the time of harvest was satisfactory. The cause of the nonfunction was probably rejection.The second patient received anti-lymphocyte globulin (ALG) for seven days, and continued on triple therapy. She had good primary function, and the DTPA nuclear scan on the first postoperative day showed good perfusion and excretion of the transplanted kidneys (Figure 2). No episode of rejection occurred, and the graft was still functioning well at 63 months. Her last creatinine level was 135 μmol/L.Case number 3 lost her en bloc transplant due to renal vein thrombosis on the first postoperative day. The fourth patient was a 14-year-old female who received an en bloc kidney transplant in October 1993. She received ALG for eight days, and then continued with triple therapy. She had four episodes of biopsy-proven rejections, and was treated successfully with pulse therapy. In November 1997, her renal function was satisfactory, but she returned 10 days later with severe rejection. This was because she had stopped her medication for three days. She was treated with pulse therapy and OKT3 for 12 days without improvement, losing her graft 50 months after transplantation because of noncompliance.

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“…These observations support the use of young donor kidneys into pediatric as opposed to adult recipients since pediatric grafts are better able to acclimatise to the needs of growing children. Although still somewhat contentious, reports, including one using the United Network of Organ Sharing (UNOS) database, suggest an advantage of using of en bloc over single kidneys from young donors [4,[24][25][26].…”

Section: Advantages Of En Bloc Over Solitary Grafts From Young or Idementioning

confidence: 99%

Expanding the Organ Donor Pool: Using En Bloc Kidneys in Pediatric Recipients

Lau¹,

Butani²

2012

J Nephrol Therapeut

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Outcome of en Bloc and Single Kidney Transplantation From Very Young Cadaveric Donors1,2,3,4,5,6

Cited by 113 publications

References 33 publications

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

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

Single Center Experience of En Bloc Kidney Transplantation and Review of Literature

Expanding the Organ Donor Pool: Using En Bloc Kidneys in Pediatric Recipients

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