SAN FRANCISCO—Dual kidney transplants (DKTs) using organs from marginal donors that might otherwise be discarded are a viable option that could help counteract the growing shortage of acceptable single kidneys, researchers reported at the 2014 World Transplant Congress.
Robert J. Stratta, MD, and colleagues at Wake Forest School of Medicine in Winston-Salem, N.C., studied 72 DKTs performed over a 12-year period, including 45 (62.5%) using expanded criteria donor (ECD) kidneys, 17 (23.6%) using kidneys donated after cardiac death (DCD), and 10 (13.9%) using standard criteria donor (SCD) kidneys.
After a mean follow-up time of 58 months, the actual patient and graft survival rates were 85%, and 71%, respectively. The 1-year and death-censored graft survival rates were 90% and 80%. The outcomes did not differ by donor source or recipient age. Delayed graft function (DGF) and primary non-function occurred in 24% and 2.8% of recipients, respectively.
“The increasing disparity between organ supply and demand challenges the transplant community to maximize and optimize the use of organs from all consented deceased donors,” Dr. Stratta told Renal & Urology News. “Growing acceptance and use of marginal donor kidneys, defined as having limited renal functional capacity, have been tempered by concerns that these kidneys have inferior outcomes.”
At a mean 36 months post-DKT, 11 patients died, 8 with a functioning graft. Graft survival and function were comparable to that of concurrent single SCD kidney recipients and superior to that of concurrent single ECD kidney recipients.
Results also showed that in the absence of DGF or acute rejection, the proportion of renal function transplanted from donor to DKT recipients was 77% compared with 55%-58% among patients receiving single kidneys from SCD, ECD, or DCD donors.
“Medium term outcomes, similar to concurrent SCD single kidney recipients, can be achieved and waiting times can be reduced in a predominantly older recipient population with primarily ECD kidneys,” the authors concluded in their poster presentation.
Both donors and recipients had a mean age of 60 years; 29 donors and 26 recipients were aged 65 years and older. Nearly all of the transplanted kidneys were refused by multiple centers, with many targeted for discard in the absence of DKT utilization.
The recipients had mean pre-transplant waiting and dialysis vintage times of 12 months and 25 months, respectively.
In an effort to use marginal donor kidneys not considered suitable for single kidney transplants, for whatever reasons, the application of DKT has evolved in lieu of organ discard, said Dr. Stratta, who is a transplant surgeon and a professor of surgery.
“At present, the decision to perform a DKT versus either 2 single kidney transplants or discarding both kidneys is multifactorial and usually occurs when both kidneys have been refused for single kidney transplantation by multiple centers and have accrued prolonged cold ischemia time,” he explained. “In addition to donor organ quality and excessive cold ischemia, the greatest potential risk factor for inferior outcomes in DKT is poor recipient selection.”
Outcomes are optimized when a systematic approach based on careful assessment of donor and kidney quality as well as appropriate recipient selection is implemented, he said.