Comparison of first and second kidney transplants from the same deceased donor.
BACKGROUND
Cold ischaemic time (CIT) may negatively influence graft function, increase the risk of acute rejection, and have adverse effects on graft and patient survival. This holds true especially for expanded criteria donors. As multi-centre studies on the impact of CIT are potentially biased, we performed a retrospective single-centre analysis of both kidneys from the same deceased donor transplanted consecutively into two recipients.


METHODS
A retrospective analysis of 80 kidneys from 40 donors transplanted into 80 recipients between January 1989 and December 2007 was conducted. Transplantations were performed successively due to logistic reasons resulting in a longer CIT for the second transplantation. We compared the outcome of the first (Rank 1) vs. the second (Rank 2) transplantation of the same donor. Ten donors/20 kidneys were allocated in the Eurotransplant Senior Program (ESP).


RESULTS
Overall, no significant difference was found for the number of rejections, delayed graft function (DGF), functional data (creatinine, creatinine clearance and GFR) or graft survival despite a significant difference in CIT of Rank 1 recipients (8.3 h) vs. Rank 2 recipients (14.3 h). Subgroup analysis of kidneys transplanted in the Eurotransplant Senior Program (CIT Rank 1: 7 h vs. Rank 2: 12 h) also showed no difference for all the items studied. Donor kidneys ≥65 years transplanted at Rank 2 had a higher rate of DGF when compared with kidneys from donors <65 years transplanted at Rank 1, and function was better for the young Rank 1 recipients for all the time points measured. Graft- and patient survival did not differ.


CONCLUSIONS
We found no difference between the successively transplanted kidneys of the same donor, not even for the expanded criteria donor organs. Nevertheless, assuming a 'safe' CIT is not justified, and CIT should always be kept as short as possible.
Giessing
Markus
M
Department of Urology, Heinrich Heine University Hospital, Duesseldorf, Germany. markus.giessing@med.uni-duesseldorf.de
Fuller
Tom Florian
TF
Friedersdorff
Frank
F
Deger
Serdar
S
Schmidt
Danilo
D
Neumayer
Hans-Helmut
HH
Budde
Klemens
K
Liefeldt
Lutz
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D050377:Cold Ischemia; D003404:Creatinine / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000502:physiology*; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D055815:Young Adult
D003404:Creatinine