Monolateral placement of both kidneys in dual kidney transplantation: low surgical complication rate and short operating time*

Abstract

Summary Dual kidney transplantation (DKT) from marginal donors is increasingly used at many centers to help cope with the organ shortage problem. The disadvantages of DKT consist in longer operating times and the risk of surgical complications. DKT can be performed in two ways, i.e. using monolateral or bilateral procedures. From October 1999 to June 2005, 58 DKTs were performed at our unit. In 29 cases (group I), the kidneys were extraperitoneally placed bilaterally in the iliac fossae via two separate incisions; as of June 2003, monolateral kidney placement was preferred in 29 cases, whenever compatible with the recipient's morphological status (group II). After a mean follow‐up of 51 ± 19 months for group I and 15 ± 7 months for group II, all patients are alive with 1‐year graft survival rates of 93% and 96%, respectively. Mean operating times were 351 ± 76 min in group I and 261 ± 31 min in group II (P = 0.0001). The mean S‐creatinine levels in groups I and II were 132 ± 47 and 119 ± 36 μmol/l, respectively, at 1 year. We observed eight surgical complications in group I and seven in group II. Both techniques proved safe, with no differences in surgical complication rates. The monolateral procedure has the advantage of a shorter operating time and the contralateral iliac fossa remains available for further retransplantation procedures.

Outcomes of Dual Adult Kidney Transplants in the United States: An Analysis of the OPTN/UNOS Database

“…Longer time under anesthesia, and twice the number of dissections and vascular anastomoses, may contribute to a higher surgical risk with DKT (18). It is important to note, however, that since the first reported DKT in 1996 (19), there have been various surgical techniques, including unilateral placement of both kidneys (20), which successfully minimize the length of surgery and may ameliorate some of these concerns. Additionally, as reported above, in contrast to concerns regarding DGF, we found lower rates of DGF with DKT compared to single ECD transplants.…”

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“…24 Monolateral placement of both kidneys reduces length of the surgical procedure and hospital stay. Ekser and associates 18 reported 2% renal vein thrombosis in both the bilateral and ipsilateral DKT groups (total of 58 DKTs), and no difference in the complication rates between both techniques. A larger study also showed no differences in complication rates between ipsilateral DKT and SKT.…”

“…17 This technique results in graft survival at 1 year similar to that shown with the bilateral technique (96% vs 93%) and shorter operative time (261 ± 31 vs 351 ± 76 min; P = .0001). 18 A modification was described in Ekser and associates in a report of 29 unilateral extraperitoneal DKTs. 18 The right kidney was placed superiorly, but the renal vein was extended using the donor's inferior vena cava patch.…”

“…18 A modification was described in Ekser and associates in a report of 29 unilateral extraperitoneal DKTs. 18 The right kidney was placed superiorly, but the renal vein was extended using the donor's inferior vena cava patch. It was anastomosed to the external iliac vein instead of the inferior vena cava.…”

“…This technique has shorter operative time and length of hospital stay and a lower delayed graft function rate versus bilateral placement of DKT done by same team. 18 In a larger series, unilateral DKT was performed in 100 patients by the same team. Shorter operative time was observed (260 ± 35 min), with 95% of placements on the right side.…”