The study purpose was to analyze outcomes in recipients of pediatric dual en bloc (EB) kidneys from small pediatric donors (SPDs, age ≤ 3 years) and dual kidney transplants (DKTs) from adult marginal deceased donors (MDDs) in the context of the Kidney Donor Profile index (KDPI). METHODS: Single center retrospective review of dual EB KTs from SPDs ≤ 3 years of age and DKTs from adult MDDs. Recipient selection included primary transplant, low BMI, low immunologic risk, favorable anatomy, no anti-coagulation or thrombophilia, and informed consent. All patients (pts) received depleting antibody induction with FK/MPA/± prednisone. RESULTS: From 2002-2014, we performed 34 dual EB and 72 adult DKTs. Mean donor ages were 17 months SPD and 60 years MDD, mean donor weights were 11.0 kg SPD and 75.9 kg MDD, and proportions of male donors were 50% SPD and 39% MDD. Mean donor serum creatinine (SCr) levels were 0.37 SPD and 1.3 mg/dl MDD, mean cold ischemia times were 21.0 SPD and 26.5 hours MDD, and mean KDPIs were 73% SPD and 83% MDD. Adult DKT recipients were older (mean age 38.0 EB and 59.6 years DKT), less frequently male (62% EB and 40.3% DKT), and had shorter waiting times (mean 25.2 EB and 12.3 months DKT) and time on dialysis (mean 41.2 EB and 25 months DKT). With mean 5-year follow-up, actual pt (94% EB and 85% DKT) and graft survival (GS, 91% EB and 71% DKT) rates were higher in EB compared to DKT. Death-censored kidney GS rates were 93.9% EB and 80% DKT. Delayed graft function (DGF) rates were 12% EB and 25% DKT. Mean 2-year SCr levels were 1.1 EB and 1.5 mg/dl DKT whereas 2-year GFR levels were 75 EB and 51 ml/min/1.73 m² DKT. Based on actuarial 5-year GS rates, the calculated KDPIs for dual EB and DKTs were <1% and 50%, respectively. EB KT outcomes from SPDs were comparable to concurrent living donor KTs and superior to standard criteria donor (SCD) single KTs at our center whereas outcomes following DKT were comparable to concurrent SCD single KTs and superior to ECD single KTs. CONCLUSION: With appropriate donor and pt selection, excellent mid-term outcomes can be achieved with either dual EB or adult DKTs, which may expand the limited donor pool and prevent kidney discard. The KDPI is not accurate for predicting outcomes from either dual EB from SPDs or DKT from adult MDDs, which may prevent centers from otherwise accepting these organs for KT.

CITATION INFORMATION: Felts D, Khan M, Alradawna B, Farney A, Rogers J, Orlando G, Reeves-Daniel A, Palanisamy A, Doares W, Kaczmorski S, Stratta R. Lack of Utility of KDPI in Dual Kidneys from Donors at the Extremes of Age. Am J Transplant. 2017;17 (suppl 3).

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