Dual Deceased Donor Kidney Transplants: Maximizing Utilization of Suboptimal Kidneys
Renal Transplant, Charleston Area Medical Center, Charleston, WV
Meeting: 2022 American Transplant Congress
Abstract number: 722
Keywords: Donors, marginal, Kidney transplantation, Outcome, Resource utilization
Topic: Clinical Science » Kidney » 32 - Kidney Deceased Donor Selection
Session Information
Session Name: Kidney Deceased Donor Selection
Session Type: Poster Abstract
Date: Saturday, June 4, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Halls C & D
*Purpose: To demonstrate that dual transplant of marginal kidneys is an underutilized strategy to minimize discard rates and mitigate organ shortage.
*Methods: We compared dual kidney transplant recipients (DUAL) with single deceased donor recipients (SINGLE) aged 50 years and older from 12/5/14 to 9/12/21. Patients were followed thru 11/5/21. All received antibody induction; tacrolimus, mycophenolate +/- prednisone for maintenance. Recipient variables were age, time on the waitlist, EPTS, BMI. Donor factors: age, KDPI, PHS, DM diagnosis, imported kidneys, ischemia time, and pump. Transplant outcome: primary non-function, length of stay, and patient and graft survival. We described the sequence number, surgical approach, length of surgery, intra- and peri-operative complications, acute rejection at 6 months, and creatinine at 6 months and 1 year of DUAL.
*Results: 19 DUAL and 257 SINGLE transplants were performed. Follow up was 33 months (2-53).
| Recipient | DUAL n=19 | SINGLE n=257 | p-value |
| Mean Age, yrs (range) | 66 (50-76) | 62 (50-79) | |
| Age >65 | 12 (63%) | 101 (39%) | 0.038 |
| Age >70 | 10 (27%) | 33 (13%) | 0.0001 |
| Gender (F) | 9 (47%) | 96 (37%) | ns |
| Time on Waitlist | 628 (7-1255) | 413(2-4973) | ns |
| BMI ave | 29.59 (24.4-35.5) | 30.53 (17-44) | ns |
| EPTS >80 | 0.63 (0.29-0.98) 5 (26%) | 0.62 (.15-1.0) 71 (28%) | ns |
| Donor | DUAL | SINGLE | p-value |
| Mean Age, (range); >65 | 60 (41-74); 6 (32%) | 48 (10-74); 28 (11%) | 0.008 |
| KDPI (range); >85 | 89 (74-98); 15 (79%) | 46 (1-100); 53 (21%) | 0.00001 |
| DCD | 5 (26%) | 117 (46%) | 0.028 (single) |
| ECD | 16 (84%) | 81 (32%) | 0.0001 |
| DM | 5 (26%) | 45 (18%) | ns |
| PHS high risk | 3 (16%) | 80 (31%) | ns |
| Import | 16 (84%) | 117 (46%) | 0.0011 |
| *Ischemia time, hrs (range); Over 20 hrs | 22 (11-36.5); 10 (52%) | 21 (4-40); 145 (56%) | ns |
| Pump | 9 (47%) | 164 (64%) | ns |
| TRANSPLANT OUTCOME | DUAL | SINGLE | p-value |
| DGF | 2 (11%) | 40 (16%) | ns |
| LOS mean (range) | 8.8 (4-42) | 7.2 (3-147) | ns |
| Primary Non-function | 0 | 3 | |
| Death-censored Graft Failure | 1 | 8 | ns |
| Death | 0 | 14 |
DUAL average sequence was 2330 (32-24,241). Operative time was 258 minutes (181 to 395). All were extraperitoneal: 15 infraumbilical midline approach and 4 bilateral lower quadrant incisions; 8 had drains. There were no intraoperative complications but 3 reoperations: 2 for bleeding (one required contralateral allograft nephrectomy for thrombosis) and one for extraction of a fractured drain. There were 8 readmissions. 2 had successfully treated biopsy-proven rejection. The only graft loss was from CMV infection. There were no patient deaths. Average creatinine at 6 months and 1 year were 1.2 mg/dl and 1.09 mg/dl, respectively.
*Conclusions: Dual deceased donor transplants utilizing marginal kidneys remain an excellent option, especially for selected recipients who are older. This may alleviate the discard rate of less than ideal kidneys and yet allow marginalized candidates to be transplanted.
To cite this abstract in AMA style:
Nagaraju S, Vaishnav S, Boggs K, Cook T, Jones A, Africa JB. Dual Deceased Donor Kidney Transplants: Maximizing Utilization of Suboptimal Kidneys [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/dual-deceased-donor-kidney-transplants-maximizing-utilization-of-suboptimal-kidneys/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress