Background

Expanded criteria circulatory death donors (DCD) may represent an underutilised donor pool. Our centre has used urgent pre-implantation biopsy (Remuzzi score) to guide single (SKT) vs dual (DKT) kidney transplantation: here we report outcomes for a cohort of donors over 65.

Methods

DCD kidney only transplants from donors over 65 performed between 2009 and 2016 (n=39 DKT, n=123 SKT) were identified from a prospectively maintained database. 1, 3 and 5 year eGFR and death censored graft survival was compared for single and dual transplants.

Results

Despite more severe baseline injury (Remuzzi scores 4.3 vs 3.4, p<0.001), higher rates of hypertension (69% vs 46%, p=0.013) and diabetes (18% vs 7%, p=0.049) DKTs had better death censored graft survival at 5 years (94% vs 86%) with better 1 and 3 year eGFR (47.5mlsmin-1 vs 36.9mlmin-1, p=0.003; 53.6mlmin-1 vs 42.53mlmin-1, p=0.041) compared to SKTs from donors with otherwise similar clinical characteristics. This difference was most marked for kidneys with moderately severe (Remuzzi score >4) baseline injury; whose five-year survival was 100% when implanted as a dual, but only 80% when implanted singly. In contrast, no survival difference was observed between dual and single transplantation for kidneys with favourable (<4) scores.

Conclusion

Our results indicate that ECD DCD kidneys can be used safely, and suggests that preimplantation biopsy analysis can guide single vs. dual transplantation to mitigate the risk of early graft failure.

CITATION INFORMATION: Ayorinde J., Pettigrew G. Using the Remuzzi Score to Guide Single vs. Dual Transplantation Mitigates the Risk of Early Graft Failure Am J Transplant. 2017;17 (suppl 3).

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