Middle and long-term outcomes of dual kidney transplant: a multicenter experience.

Abstract

INTRODUCTION:

Dual kidney transplantation (DKTx) to reduce the disparity between demand and supply of organs was evaluated in two Italian centers (Bari and Novara).

MATERIALS AND METHODS:

Between October 2000 and October 2011, we performed 97 DKT (26 ipsilateral/71 bilateral) following routine biopsy of all kidneys obtained from expanded criteria donors by Remuzzi-Karpinsky scores. The reference group was 379 single grafts from donors older than 60 years single kidney transplantation ([SKT] × > 60).

RESULTS:

Good postoperative renal function was observed in 56 DKTx (57.7%); whereas acute tubular necrosis requiring dialysis was observed in 41 (42.3%) patients. After a mean follow-up of 60 months, DKTx graft survivals were 96%, 93%, and 90% and patient survivals, 96%, 91%, and 91% at 1, 3, and 5 years, respectively. Complications in expanded criteria donor kidney transplantations included a high rate of cytomegalovirus (CMV) disease especially dual kidney cases. DKTx represented the only independent risk factor for CMV disease upon multivariate analysis (odds ratio [OR] 2.33, 95% confidence interval [CI] 1.28-4.2; P = .006). We did not observe any significant difference in graft or patient survival between DKTx and SKTx > 60 years.

CONCLUSIONS:

We observed good outcomes up to 5 years after transplantation in terms of graft and patient survival despite the use of inferior grafts. Comparing DKTx and SKT > 60, we noted that the mean Karpinski score for SKTx was significantly better than DKTx, although patient and graft survivals were similar. This trend confirms that the use of a biopsy to allocate expanded criteria donor kidneys may be too protective; therefore, the criteria to select DKTx require further refinement.

• Authors: S V Impedovo, E De Lorenzis, A Volpe, L Gesualdo, G Grandaliano, S Palazzo, G Lucarelli, C Bettocchi, C Terrone, P Stratta, M Quaglia, M Battaglia, P Ditonno
• Journal: Transplantation proceedings (Transplant Proc) Vol. 45 Issue 3 Pg. 1237-41 (Apr 2013) ISSN: 1873-2623 [Electronic] United States
• PMID: 23622667 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Kidney Transplantation
• Male
• Middle Aged
• Patient Compliance
• Treatment Outcome