Elsevier

Surgery

Volume 140, Issue 4, October 2006, Pages 597-606
Surgery

Central Surgical Association
Experience with dual kidney transplants from donors at the extremes of age

Presented at the 63rd Annual Meeting of the Central Surgical Association, Louisville, Kentucky, March 9-11, 2006.
https://doi.org/10.1016/j.surg.2006.07.004Get rights and content

Background

Dual kidney transplantation (DKT) from donors at the extremes of age represents one approach to expanding the organ donor pool. The purpose of this study was to review our experience with DKT from older donors and en bloc KT (EBKT) from small pediatric donors.

Methods

Deceased donor KTs performed at our center between October 2001 and November 2005, were reviewed retrospectively. If the calculated creatinine clearance in an expanded criteria donor was <65 mL/min, then the kidneys were transplanted dually into a single adult recipient. If a pediatric donor weighed <15 kg, then the kidneys were transplanted en bloc. In both instances, low-risk recipients were chosen (primary transplant, low sensitization, body mass index <25 kg/m2, human leukocyte antigen matching). Donor, recipient, and transplant characteristics, waiting time, and outcomes were examined.

Results

Of a total of 279 deceased donor KTs during the 49-month study period, 15 (5%) recipients underwent DKT and 5 (2%) underwent EBKT. Mean donor age was 65.4 years and 21.4 months in the DKT and EBKT groups, respectively. Patient survival rates in both groups were 100% with a mean follow-up of 22 months (minimum, 6 months). Kidney graft survival rates were 80% (12/15) and 60% (3/5) in the DKT and EBKT groups, respectively. The combined incidence of delayed graft function was 10%. Mean 12-month glomerular filtration rates were 46 mL/min and 66 mL/min in the DKT and EBKT groups, respectively.

Conclusions

DKT using kidneys from marginal elderly donors and EBKT from small pediatric donors appear to offer a viable option to counteract the shortage of acceptable kidney donors.

Section snippets

Study design

We conducted a retrospective chart review of all DD KTs performed at Wake Forest University Baptist Medical Center from October 1, 2001, through November 1, 2005. DKT and EBKT recipients were identified and analyzed in detail.

Definitions

The ECDs were defined by the UNOS definition as all DDs ≥60 years and DDs 50 to 59 years of age with any 2 of the following criteria: (1) history of donor hypertension; (2) cerebrovascular cause of brain death; or (3) donor serum creatinine (SCr) >1.5 mg/dL.7 In this

Results

A total of 279 patients underwent DD KT during the 49-month study period. Of these, 15 patients underwent DKT and 5 underwent EBKT, which represents 7% of our DD KT activity. Virtually all of these donor organs were turned down by multiple centers, and most were targeted for organ discard. The mean donor age was 65.4 years in the DKT group, 11 of 15 donors had a history of hypertension, and 10 of 15 sustained brain death attributable to cerebrovascular causes. The mean donor age was 21.4 months

Discussion

Expanding the donor pool for kidney transplantation has been an ongoing challenge. The first report of EBKT into an adult recipient was by Meakins et al20 in 1972. Subsequently, there have been numerous reports of successful EBKT from small pediatric donors.11, 12, 13, 14, 21 In the last decade, transplant centers have increasingly reported the use of DKT from marginal, older donors.8, 9, 10 Both of these techniques involve the use of nonstandard donors; thus, concerns have been raised

References (24)

  • C.M. Lee et al.

    The kidneys that nobody wanted: support for the utilization of expanded criteria donors

    Transplantation

    (1996)
  • R.J. Stratta et al.

    Increased kidney transplantation utilizing expanded criteria deceased organ donors with results comparable to standard criteria donor transplant

    Ann Surg

    (2004)
  • Cited by (35)

    • Dual Kidney Transplantation from Donors at the Extremes of Age

      2019, Journal of the American College of Surgeons
      Citation Excerpt :

      At our center, no specific upper age limit was an absolute contraindication to dual KT; the oldest DKT recipient in this series was 79 years. All patients underwent a comprehensive pre-transplant medical, psychosocial, and financial evaluation, with emphasis placed on the cardiovascular system to determine operative risks and physiologic age.5,29-36,45 Specific exclusion criteria in the elderly included the presence of dementia, nursing home residence, poor overall functional status or frailty, lack of social support, advanced disease or organ failure in an extra-renal organ system, recent malignancy, limited life expectancy, or severe cardiac or vascular disease.5,29-36,45

    • Kidney Transplantation in the Elderly

      2017, Kidney Transplantation, Bioengineering, and Regeneration: Kidney Transplantation in the Regenerative Medicine Era
    View all citing articles on Scopus
    View full text