Researchers: Consider Dual Kidney Transplants

SAN DIEGO—Dual kidney transplants (DKT), in which transplant patients receive both of a donor's kidneys, have outcomes similar to those of recipients of expanded criteria donor (ECD) kidneys, researchers reported at Kidney Week 2012.

In a poster presentation, investigators at Columbia University Medical Center in New York observed that DKT is not a consideration in the current allocation algorithm in the United States. Many kidneys used for DKT otherwise would have been discarded because of their high-risk characteristics, they noted. These characteristics include a donor age older than 60 years, a terminal creatinine level higher than 2.5 mg/dL, an estimated glomerular filtration rate below 65 mL/min/1.73 m2, donor diabetes or hypertension, and moderate glomerulosclerosis.

Using data from the United Network for Organ Sharing database, Sowmini Medavaram, MD, and colleagues identified 1,601 DKT patients and 23,457 ECD transplant patients. Donors of the dual kidney transplant patients were aged 50 years and older. The DKT group had a significantly greater proportion of diabetics than the ECD group (16.8% vs. 11.7%).

The DKT and ECD transplant patients had an acute rejection rate of 14.8% and 13.4%, respectively, and a chronic rejection rate of 35% and 38.4%, respectively. Graft thrombosis occurred in 6.5% and 5.1% of patients. Death with a functioning kidney occurred in 6.7% and 4.3%, respectively. The 90-day post-transplant mortality rate was 3.9% and 3.1%. The five-year death-censored graft survival rate was 51% in both groups. None of the outcome differences between the groups was statistically significant.

Dr. Medavaram's group concluded that DKT needs to be optimized by offering them as part of an ECD algorithm and should be considered prior to discarding available kidneys.

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