1. Early Single Centre Results of Dual Kidney Transplantation from Marginal Donors
T. Rana, L. Szabo, A. Asderakis, E. Ablorsu
Cardiff Transplant Unit, University Hospital of Wales, Cardiff, UK
INTRODUCTION
METHOD
Increasing shortage of donor kidneys dictates constant review of organ quality and utilisation.
Any positive result from a potential donor is superior to rejecting the organs outright.
The most common reason for donor rejection was age with a positive past medical history, especially of Diabetes Mellitus (DM) and Hypertension (HTN). The results of graft survival and renal function from marginal donors with these characteristics has been demonstrated to be inferior to Standard Criteria Donors (SCD) in the past.
The implantation of both kidneys from a marginal donor allows us to utilise organs that would either be rejected outright or provide insufficient graft function to the recipient.
A comparison of graft function and complication rates was required to validate dual kidney transplantation.
Donor selection criteria for Dual Kidney Transplant:
DCD donors older than 70 years of age,
DCD donors older than 65 with DM, HTN or both; &
DBD donors older than 70 years of age with DM, HTN or both.
Recipient exclusion factors:
DM, Polycystic kidney disease, severe cardiovascular disease, treatment with Clopidogrel or Warfarin and BMI > 31.
Transplant Technique:
Both kidneys were implanted on the same side (ipsilateral).
Method:
We compared outcomes of consecutive Dual Kidney Transplant (DKT) between Feb 2011 and April 2014 with our historic single kidney transplant (SKT) recipient group with identical donor criteria to the DKT group. Data was collected prospectively in the DKT group and retrospectively in the earlier single transplant group.
RESULTS
Patients included: 34 DKTs vs 51 SKTs
Median Recipient Age: (years) 67.5 vs. 65 (p = 0.02)
Higher Mean eGFR: DKT vs SKT (see fig):
- 6 months: vs (p = 0.005)
12 months: 46.7 vs (p = )
Lower rate of DGF: (%) 79 vs. 82 (p = 0.73)
Rejection rate: (%) 21 vs. 27 (p = 0.47)
Mean Hospital stay: (days) 16 vs. 13 (p = 0.04)
DKT Survival
graft survival
1 year: dual 96%, single 96%
3 year: dual 96%, single 91%
p-value: 0.62
patient survival
1 year: dual 92%, single 98%
3 year: dual 70%, single 91%
p-value: 0.07
CONCLUSIONS
Graft function and survival are improved by dual kidney transplantation when compared to single kidney transplants from similar donors.
DKTs present a viable option in the utilisation of very marginal kidney donors.
Careful selection of potential recipients is necessary due to the somewhat higher complication rate. Further studies are needed to consolidate evidence for this technique and gain wider acceptance in clinical practice.
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