Dual kidney transplantation: a case-control comparison with single kidney transplantation from standard and expanded criteria donors.
BACKGROUND
The purpose of this study was to perform a case-matched cohort analysis of dual kidney transplantation (DKT) from expanded criteria donors (ECDs) compared to single kidney transplantation (SKT) from concurrent ECDs and standard criteria donors (SCDs, defined as non-ECD).


METHODS
Deceased donor (DD) kidney transplants (KTs) performed at a single center between October 2001 and February 2006 were reviewed retrospectively. If the calculated DD creatinine clearance (CrCl) was <65 mL/min, then the kidneys were transplanted dually into a single patient. In the case of DKT and SKT from ECDs, low risk patients were chosen and informed consent was obtained. Patients in each group were matched for age, gender, race, transplant number, and time of transplant.


RESULTS
Of 294 adult DD KTs performed, 16 (5%) were DKTs, which were matched with 16 concurrent SCD and 16 ECD SKT patients. Mean donor age in years (65 DKT vs. 33 SCD vs. 61 ECD; P<0.0001) and mean donor CrCl in ml/min (54 DKT vs. 91 SCD vs. 76 ECD; P=0.002) were different between groups. Patient survival was 100% in the DKT and SCD SKT groups and 94% in the ECD SKT group (mean follow up 23-28 months); graft survival rates in the DKT, SCD, and ECD groups were 81%, 81%, and 94%, respectively (P=NS). Graft function, rejection, and morbidity were similar between groups.


CONCLUSIONS
DKT using kidneys from marginal ECDs is a viable option to counteract the growing shortage of available organs. Excellent short-term results and renal function can be achieved with older, low nephron mass donors provided that both kidneys are transplanted into a single recipient.
Moore
Phillip S
PS
Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157-1095, USA.
Farney
Alan C
AC
Sundberg
Aimee K
AK
Rohr
Michael S
MS
Hartmann
Erica L
EL
Iskandar
Samy S
SS
Gautreaux
Michael D
MD
Rogers
Jeffrey
J
Doares
William
W
Anderson
Teresa K
TK
Adams
Patricia L
PL
Stratta
Robert J
RJ
D000328:Adult; D000368:Aged; D002102:Cadaver; D016022:Case-Control Studies; D002423:Cause of Death; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D007668:Kidney; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D009657:North Carolina; D018579:Patient Selection; D011184:Postoperative Period; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists