Renal transplantation
Overall outcome
Dual Kidney Transplants From Very Old or Very Young Donors: Long-Term Outcomes and Complications

https://doi.org/10.1016/j.transproceed.2011.01.038Get rights and content

Abstract

The disparity between donors and the demand for organ transplants grows steadily. Annually, 4700 patients die on the kidney transplant waiting list in the United States. To increase utilization of deceased donor organs, we expanded our acceptable criteria to include very old (VO) or very young (VY) donors. We transplanted both such kidneys (dual transplant) into a single recipient and evaluated the long-term outcomes and complications. From July 2001 to December 2005, 16 patients (mean age 68, range 60–78) received dual kidneys from VO (mean age 72, range 60–79) donors and 6 patients (mean age 47, range 27–72) were transplanted from VY (mean age 17 months, range 2–36) donors. Seventy-four percent of these kidneys were imported after rejection by their local center due to low glomerular filtration rate (GFR) and extreme age. One- and 5-year patient survival rates were 100% and 88%, respectively. Death-censored 1- and 5-year graft survival rates for recipient of VO kidneys were 95% and 93%, and 66% and 50% for recipients of VY kidneys, respectively. Five-year graft survival rate for recipients of VO donor kidneys was 93% and was equal to the survival of standard deceased donor (SCD) kidney transplants (87%). The 5-year survival of dual transplants from VO donors was higher than expanded criteria deceased donor (ECD; P = .05). Over a mean follow-up of 66 ± 28 months, rejection rates were 10%, not statistically different than other groups. Of 22 dual transplants, four patients experienced urinary tract infections; three developed incisional subcutaneous seromas, and there were more urinary leaks compared to SCD (13.6% vs 2%, P = .002). The average 1- and 5-year estimated GFR (Cockcroft-Gault) was 57.4 and 54.6 mL/min, respectively. When properly placed in a single patient, such marginal organs are a valuable resource that offer comparable outcomes to SCD transplants and superior outcomes to ECD organs.

Section snippets

Patients and Methods

The medical records of all kidney transplant recipients transplanted in our center from July 2001 to December 2005 were reviewed. We performed DKT when the donor's estimated glomerular filtration rate (GFR) was <80 mL/min. If the donor GFR was >80 mL/min, a single kidney was transplanted. Seventy-four percent of DKTs were performed using imported organs after they were deemed unacceptable by their local center due to the donor's age. All dual kidneys were placed ipsilaterally (Fig 1) except in

Results

Donor and recipient demographics are shown in Table 1, Table 2, Table 3 Sixteen patients (mean age 68, range 60–78) received dual kidneys from VO (mean age 72, range 60–79) donors and 6 patients (mean age 47, range 27–72) were transplanted from VY (mean age 17 months, range 2–36 months) donors. All patients received antilymphocyte antibody induction therapy with Thymoglobulin (Genzyme, Cambridge, Mass, USA) at a total dose between 3 and 5 mg/kg. Recipients were maintained on a triple-drug

Discussion

Ojo showed that successful kidney transplantation prolongs patients' lives compared to maintenance dialysis.4 Although the greatest benefit appears to be provided by SCD kidneys, even recipients of ECD kidneys experience a survival advantage. The development of the DKT procedure increased the utilization rate of kidneys obtained from donors at the extremes of age that otherwise would have been discarded. The use of the DKT procedure was amply demonstrated in our study since 74% of our dual

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