Central Surgical AssociationExperience with dual kidney transplants from donors at the extremes of age
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
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Cited by (35)
Young donors with severe acute kidney injury offer an opportunity to expand the donor pool
2019, American Journal of SurgeryDual Kidney Transplantation from Donors at the Extremes of Age
2019, Journal of the American College of SurgeonsCitation 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 EraKidneys at higher risk of discard: Expanding the role of dual kidney transplantation
2014, American Journal of TransplantationOutcomes of adult dual kidney transplants by KDRI in the United States
2013, American Journal of Transplantation