Dual kidney transplantation with organs from extended criteria cadaveric donors.
OBJECTIVE
The critical shortage of kidneys available for transplantation has led to alternate strategies to expand the pool. Transplantation of the 2 kidneys into a single recipient using organs suboptimal for single kidney transplantation was suggested. We assessed results in 24 grafts allocated for dual kidney transplantation vs those in a control group of 44 designated for single kidney transplantation. Each group underwent pretransplant biopsy and recipients were age matched.


METHODS
Dual kidney transplantation was done in 24 of 1,091 transplants (2.1%) from 2001 to 2008. In patients with dual kidney transplant vs single kidney transplant mean recipient age was 60.6 vs 60.8 years, mean HLA-A, B and DR mismatches were 3.3 vs 2.9, and average patient waiting time was 15.6 vs 13.9 months. All grafts were perfused with University of Wisconsin solution with a mean cold ischemia time of 17.9 hours. On donor dual kidney biopsy in the dual kidney transplant vs single kidney transplant group the average fibrosis rate was 30% (range 25% to 45%) vs 25% (range 3% to 40%) and the glomerulosclerosis rate was 17.9% (range 3.2% to 40.7%) vs 7.1% (range 0% to 50%).


RESULTS
Good postoperative renal function was noted in 14 dual kidney transplantation cases. Acute tubular necrosis requiring dialysis developed in 5 patients as well as acute rejection in 1. Two dual kidney recipients (8%) died in the postoperative period with no single kidney deaths. One patient underwent bilateral transplantectomy. Mean anesthesia time was longer in the dual group (371 vs 212 minutes). Patient and graft survival was equivalent to that in the control group at 36 months.


CONCLUSIONS
Careful selection of marginal kidneys based on clinical and histological criteria allows the use of organs that would not ordinarily be sufficient for transplantation with acceptable outcomes. This is a valid strategy to address the organ shortage.
D'Arcy
Frank T
FT
National Kidney and Pancreas Transplantation Unit, Beaumont Hospital, Dublin, Ireland. darcyft@hotmail.com
O'Connor
Kevin M
KM
Shields
William
W
Zimmerman
Jose A
JA
Mohan
Ponnusamy
P
Eng
Molly
M
Little
Dilly M
DM
Power
Richard
R
Dorman
Anthony
A
Hickey
David P
DP
D000328:Adult; D000368:Aged; D002102:Cadaver; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008875:Middle Aged; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards