Dual deceased-donor kidney transplantation (KT) results in manageable complications and satisfactory transplant outcomes, according to a poster presentation at the 2022 American Transplant Congress (ATC 2022) in Boston, Massachusetts.
Santosh Nagaraju, MD, of Charleston Area Medical Center in West Virginia, and colleagues compared perioperative and transplant outcomes between 19 dual and 257 single kidney transplantations over 33 months of follow-up.
Donors of dual vs single kidneys were significantly older (60 vs 48 years) and a significantly greater proportion were classified as expanded criteria donors (84% vs 32%). Donations after circulatory death were significantly less prevalent in the dual than single KT groups (26% vs 46%). A Kidney Donor Profile Index (KDPI) exceeding 85 was assigned to 79% of dual and 21% of single transplants. Imported kidneys were used more often in dual than single KT procedures (84% vs 46%).
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Recipients of dual KT skewed older, the investigators reported. A significantly greater proportion were aged 65 years and older (63% vs 39%) and 70 years and older (27% vs 13%).
Perioperative Experience
All procedures were extraperitoneal with 15 taking an infraumbilical midline approach and 4 involving bilateral lower quadrant incisions, Dr Nagaraju’s team reported. Drains were placed during 8 procedures. Operative time was 258 minutes.
No intraoperative complications occurred. Among 3 reoperations, 2 occurred for bleeding (including 1 contralateral allograft nephrectomy for thrombosis) and 1 for extraction of a fractured drain.
There were 8 hospital readmissions. Biopsy-proven rejection was successfully treated in 2 cases. Cytomegalovirus infection led to the only graft loss. No patients died.
Mean serum creatinine levels at 6 months and 1 year were 1.2 mg/dL and 1.09 mg/dL, respectively.
Transplant Outcomes
Dr Nagaraju and colleagues found no significant differences between groups with respect to delayed graft function, hospital length of stay, and death-censored graft failure. In the single KT group, 3 episodes of primary nonfunction occurred and 14 deaths.
“Dual deceased donor transplants utilizing marginal kidneys remain an excellent option, especially for selected recipients who are older,” Dr Nagaraju’s team concluded in a study abstract. “This may alleviate the discard rate of less than ideal kidneys and yet allow marginalized candidates to be transplanted.”
Reference
Nagaraju S, Vaishnav S, Boggs K, Cook T, Jones A, Africa JB. Dual deceased donor kidney transplants: maximizing utilization of suboptimal kidneys [abstract]. Am J Transplant. 2022;22 (suppl 3). Presented at: ATC 2022 meeting; June 4-8; Boston, Massachusetts. Abstract 722.
