Introduction

Bridging the disparity between the kidney waiting list and donor pool remains challenging. For highly sensitised patients and older recipients the wait is contributing to an unacceptably high waiting list mortality. In the UK concerted efforts have seen a rise in DCD transplants and specialist centres have widened their donor acceptance criteria. Fast track and aggressive screening policies have paved the way for techniques such as dual kidney transplantation. First described by Remuzzi in 1996 there remains significant debate around solitary vs dual graft implants from marginal donors. A significant number of kidneys in the UK continue to be discarded due to perceived sub-optimal donor function.

Methods

All DKTs performed in a single centre between 2007 and 2017 were included. Donor selection criteria includes: age>70, GFR> 50 or 65 +/- renal risk factors (hypertension, diabetes). End points were patient and graft outcomes. Recipients were BMI <35, no history of peripheral vascular disease, non-diabetic and age >55 (emphasis on long wait time). Grafts were placed in an ipsilateral manner.

Results

There have been 65 DKTs at our institution. 42 male, 23 female, median age of 64 (48-78). All kidneys were from extended criteria donors (ECD). Median donor age was 73 (43-81). Median donor GFR was 77 mL/min/1.73m2. There were 50 DCD and 15 DBD kidneys. Median 30 day GFR was 34 (Range 9-75) mL/min/1.73m2 and median 90 day GFR was 36 (range 6-73) mL/min/1.73m2. DGF occurred in 23 patients, median duration of 6 days. Median 1,and 5 year GFR were 45 mL/min/1.73m2, and 43 mL/min/1.73m2. 1, 3 and 5 year graft survival was 90%, 89% and 89%. 95% of patients remain dialysis free.

Conclusion

This ten year review of dual kidney transplants in this centre reveals outcomes for 1 and 5 year graft survival of 90% and 89% which is comparable to national registry data of 95% and 87% respectively¹. US National 5 year graft survival data for extended criteria solitary kidneys is currently 66.9%² versus 89% in this series. Dual kidney transplants not only provide a viable dialysis free life for many higher risk recipients but provides superior outcomes than solitary extended criteria kidneys.

1.https://nhsbtdbe.blob.core.windows.net/umbraco-assetscorp/4657/activity_report_2016_17.pdf

2. Locke et al (2007), Outcomes of Kidneys from Donors After Cardiac Death: Implications for Allocation and Preservation. AJT, 7: 1797–1807.

CITATION INFORMATION: Rajput I., Farid S., Hakeem A., Jameel M., Ahmad N., Masood O. A Decade of Dual Kidney Transplantation Reveals Excellent Patient Outcomes from Otherwise Discarded Organs Am J Transplant. 2017;17 (suppl 3).

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