Single versus dual renal transplantation from donors with significant arteriosclerosis on pre-implant biopsy.
BACKGROUND
Transplantation of kidneys from donor with arteriosclerosis seen on pre-implantation biopsy has not been well studied.


METHODS
We retrospectively evaluated 20 dual kidney transplant (DKT) and 28 single (SKT) kidney transplant recipients with >or=12 months follow-up from donors with moderate arteriosclerosis (>or=25% luminal diameter narrowing).


RESULTS
Death censored graft survival was 100% and 79%, respectively (p = 0.0339). DKT recipients had significantly lower mean creatinine levels at one, three, six, and nine months and spent somewhat less time on the waiting list (181 +/- 160 vs. 318 +/- 306 d, p = 0.1429). DKT patients received kidneys from significantly older donors (64 +/- 7 vs. 54 +/- 11 yr; p = 0.0012), proportionately more expanded criteria donors (95% vs. 54%; p = 0.0029), and more donors with hypertension (81% vs. 48%, p = 0.0344) and death related to cerebrovascular accident (100% vs. 71%, p = 0.0143); however, more DKT kidneys underwent machine perfusion (95% vs. 57%, p = 0.0068). Baseline recipient variables were comparable between the two groups including age, race, gender, retransplantation, and HLA mismatch. Pre-implant biopsy was notable for similar frequencies of moderate interstitial fibrosis (10% vs. 14%, respectively) and glomerulosclerosis.


CONCLUSIONS
Among recipients of deceased-donor kidneys with >25% arteriosclerosis, short-term outcomes after DKT were superior to that of SKT grafts. This approach may help to expand the donor-organ pool while optimizing outcomes.
Kayler
Liise K
LK
Department of Surgery, University of Florida Medical Center, Gainesville, FL, USA. liisekayler@yahoo.com
Mohanka
Ravi
R
Basu
Amit
A
Shapiro
Ron
R
Randhawa
Parmjeet S
PS
D000328:Adult; D000368:Aged; D001161:Arteriosclerosis; D002102:Cadaver; D005260:Female; D006085:Graft Survival; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors