Multicenter study on double kidney transplantation.
BACKGROUND
Marginal organs not suitable for single kidney transplantation are considered for double kidney transplantation (DKT). Herein we have reviewed short and long-term outcomes of DKT over a 7-year experience.


METHODS
Between 2001 and 2007, 80 DKT were performed in the transplant centers of Bologna, Parma, and Modena, Italy. Recipient mean age was 61+/-5 years. The main indications were glomerular nephropathy (n=33) and hypertensive nephroangiosclerosis (n=14). Mean HLA A, B, and DR mismatches were 3.1+/-1.2. Donor mean age was 69+/-8 years and mean creatinine clearance was 75+/-27 mL/min. Almost all kidneys were perfused with Celsior solution. Mean cold ischemia time was 17+/-4 hours and mean warm ischemia time was 41+/-17 minutes. Mean biopsy score was 4.4. Immunosuppression was based on tacrolimus (n=52) or cyclosporine (n=26).


RESULTS
Fifty (62.5%) patients displayed good postoperative renal function. Thirty (37.5%) experienced acute tubular necrosis and required postoperative dialysis treatment; 8 acute rejections occurred. Urinary complications were 13.7% with 8/11 requiring surgical revision. There were 6 surgical reexplorations: intestinal perforation (n=2), bleeding (n=3), and lymphocele (n=1). Two patients lost both grafts due to vascular and infectious complications at 7 or 58 days after transplantation. Two patients underwent intraoperative transplantectomy due to massive vascular thrombosis. Four (5%) patients underwent transplantectomy of a single graft due to vascular complications (n=2), bleeding (n=1), or infectious complications (n=1). Graft and patient survivals were 95% and 100% versus 93% and 97% at 3 versus 36 months, respectively.


CONCLUSIONS
DKT is a safe approach for organ shortage. The score used in this study is useful to determine whether a kidney should be refused or accepted.
Bertelli
R
R
Transplant Center of Bologna, Bologna, Italy. riccardobertelli@hotmail.com
Nardo
B
B
Capocasale
E
E
Cappelli
G
G
Cavallari
G
G
Mazzoni
M P
MP
Benozzi
L
L
Dalla Valle
R
R
Fuga
G
G
Busi
N
N
Gilioli
C
C
Albertazzi
A
A
Stefoni
S
S
Pinna
A D
AD
Faenza
A
A
D005500:Follow-Up Studies; D007839:Functional Laterality; D006650:Histocompatibility Testing; D006801:Humans; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods*; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000145:classification; D012189:Retrospective Studies; D016896:Treatment Outcome