Dual-Kidney Transplants as an Alternative for Very Marginal Donors

[okarol]

Dual-Kidney Transplants as an Alternative for Very Marginal Donors: Long-Term Follow-Up in 63 Patients.

Transplantation. 2010 Oct 1;

Authors: De Serres SA, Caumartin Y, Noël R, Lachance JG, Côté I, Naud A, Fradet Y, Mfarrej BG, Agharazii M, Houde I

BACKGROUND.: Organ shortage has led to the use of dual-kidney transplant (DKT) of very marginal donors into a single recipient to increase the use of marginal organs. To date, few data are available about the long-term outcome of DKT and its usefulness to increase the pool of available organ. METHODS.: We conducted a single-center cohort study of DKTs with longitudinal follow-up over an 8-year period. Between 1999 and 2007, 63 DKTs were performed. All kidneys from donors younger than 75 years refused by all centers for single transplantation, and kidneys from donors aged 75 years or older were routinely evaluated based on preimplantation glomerulosclerosis. Renal function, patient or graft survival, and perioperative complications were compared with 66 single kidneys from expanded criteria donors (ECD) and 63 ideal kidney donors. RESULTS.: After a median follow-up of 56 months, patient or graft survival was similar between the three groups. Twelve-, 36-, and 84-month creatinine clearance were similar for DKT and ECD (12 months: 58 and 59 mL/min; 36 months: 54 and 60 mL/min; and 84 months: 62 and 51 mL/min, respectively). For the study period, the routine evaluation of very marginal kidneys for DKT in our center has led to an increase of 47% in the transplants from donors aged 50 years or older, which represent 12% at the level of our organ procurement organization. CONCLUSIONS.: DKT patients can expect long-term results comparable with single kidney ECD. The implementation of a DKT program in our unit safely increased the pool of organs from marginal donors.

PMID: 20921934 [PubMed - as supplied by publisher]

[MooseMom]

That's very interesting and gives us a modicum of hope.  Thanks for posting this.  With ever increasing demand for donor kidneys, I think there will be studies on all kinds of ways to meet demand.

[Zach]

Of course one has to balance the fact that Deceased Donor ECD Kidney Transplants do not last as long as non-ECD kidneys.

After five years, only about 55% of ECD kidneys continue working, and after 10 years about 26% continue to work.

For a 70-year-old, those are good statistics.  For someone younger, that's debatable.
http://www.ustransplant.org/annual%5FReports/current/508b_agecat_ki.htm

[MooseMom]

Zach, you are right.  As always, you have to look at all of the evidence and make the right decision for you.  I'm just pleased to see doctors thinking "outside the box" because the bottom line is that I suspect that there will be ever increasing demand and never enough perfect organs.