A single‐center experience with 200 dual kidney transplantations

Abstract

This study reports on a large series of 200 dual kidney transplantations (DKTs) from expanded criteria donors (ECDs) and proposes specific ways to optimize outcomes. Data concerning 200 DKTs performed in the last 14 yr were retrospectively analyzed. Kidneys from high-risk ECD were allocated for use in DKTs on an old-for-old basis after histological assessment. Different surgical techniques and immunosuppressant regimens were used over time, and the outcomes are discussed. Donors and recipients were a median 73 (70-77) and a 62 (58-67) yr old, respectively. Delayed graft function occurred in 31.5% of cases, and acute rejection in 13.5%. Patient and graft survival at five yr were 90.4% and 85.8%, respectively. Unilateral kidney placement was preferred for 75% of patients, and was associated with a low rate of surgical complications. Our current standard therapy comprising low-dose calcineurin inhibitors (CNIs) associated with mammalian target of rapamycin inhibitors (mTOR) and steroids appears to offer the best risk/benefit profile for elderly patients undergoing DKT. In our experience, outcomes after DKT can be improved by: (i) kidney clinical-histological assessment; (ii) unilateral kidney placement; (iii) minimal use of CNI associated with mTOR.

Dual kidney transplant techniques: A systematic review

“…The small number of patients in all of these studies, but especially in the studies examining outcomes in patients who had transplanted kidneys placed unilaterally, makes it difficult to draw conclusions regarding the superiority of one technique. Unfortunately, a recently published study which included 200 patients could not be included as neither patient nor graft survival was reported according to the type of surgical technique used, and an attempt to gain further information from the corresponding author was unsuccessful …”

“…(Medina‐Polo [josemedinapolo@movistar.es], email, July 26, 2016). By way of contrast, in Rigotti's recently published review of 200 dual kidney transplants, it is stated that a major impetus behind the move from bilateral placement to unilateral placement with separate anastomoses was driven by reduced operating time, faster patient recovery, and the ability to leave the contralateral iliac fossa untouched in case of a need for retransplant …”

Safety of dual kidney transplantation compared to single kidney transplantation from expanded criteria donors: a single center cohort study of 39 recipients

“…39,41,43,45,[53][54][55][56][57][58][59], as well as the rates of ureteral stenoses (10.3% vs 0-11.1%, Ref. 38,39,41,43,56,[58][59][60][61][62][63], ureteral fistulas (2.6% vs 0-17% Ref. [37][38][39]41,[43][44][45]53,55,56,59,62,64,65), hematomas (15.4% vs 1-35.5%, Ref.…”

Dual Kidney Transplant: Clinical Experience and Overview of Surgical Techniques

“…The incidence of DGF has been reported from 20% to 30% in dual kidney transplant [12,15]. The incidence of DGF may be attributed to longer CIT [16,17]. The CIT and DGF are the most important predictors for short and long-term graft survival.…”