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

Gill, Jagbir; Cho, Yong W.; Danovitch, Gabriel M.; Wilkinson, Alan H.; Lipshutz, Gerald S.; Pham, Phuong‐Thu T.; Gill, John S.; Shah, Tariq; Bunnapradist, Suphamai

doi:10.1097/01.tp.0000296855.44445.af

Cited by 86 publications

(106 citation statements)

References 21 publications

(23 reference statements)

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“…Another paper compared calcineurin-inhibitor-free with cyclosporine-based immunosuppression protocols and reported significantly lower rates of delayed graft function (DGF) and a lower rate of cytomegalovirus infection in the sirolimus group with no difference in creatinine at 1 year. 26 The incidence of acute rejection in DKT recipients was shown to be lower than it was in SKTs, 6,12,14 which suggests the possibility that increasing the antigenic load does not enhance immune response. 13 …”

Section: Immunosuppression Protocolmentioning

confidence: 99%

“…Andres and 2000 P, SC 21 15 ± 5 Age 60 to 74 y with 100% (12) 95% (12) PNF, AR were comparable with SKT, associates 17 GS 15% to 50%, age IF was significantly higher comparable ≥ 75 with GS < 50% with SKT Bunnapradist 2003 R, MC 403 36 Kidneys not suitable ---62% (36) PNF was higher, DGF, AR was and associates 18 for SKT according UNOS comparable with SKT, and overall graft survival was lower, apart from DKT with donors over 55 y of age when graft survival was comparable with SKT. 7 However, subsequent analyses of these patients reveals that the recipients of DKTs from donors 54 to 60 years old had low serum creatinine levels up to 2 years after transplant and that may mean that these kidneys could have been used for an SKT.…”

Section: Introductionmentioning

confidence: 99%

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Dual Kidney Transplant: A Single-Center Experience and Review of the Literature

Balaz

Rokošný²,

Wohlfahrt³

et al. 2013

Exp Clin Transplant

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Objectives: Adult dual kidney transplant is a strategy to overcome the imbalance between limited nephron mass supplied from an older donor and a recipient with a metabolic request. Materials and Methods: In our report, we review the literature and present our single-center experience. From June 2007 until July 2012, nine hundred twenty-eight single and seventeen dual kidney transplants from deceased donors were performed. Results: The average donor was 71.5 ± 3.6 years of age with an average serum creatinine, creatinine clearance, and an average number of sclerotic glomeruli, 106.1 ± 44.2 µmol/L, 0.97 ± 0.37 mL/s, and 22.4 ± 14.2. Immediate graft function and acute rejection episodes were observed in 75% and 6% of patients. The overall patient survival rates at 1 and 2 years after transplant were 93%. The overall graft survival rates at 1 and 2 years were 88%. Conclusions: Previous studies and our single-center experience suggest that the dual transplant procedure may help improve results of kidney transplants from expanded criteria donors and extend the donor pool by using kidneys that would be discarded otherwise.

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Section: Immunosuppression Protocolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dual Kidney Transplant: A Single-Center Experience and Review of the Literature

Balaz

Rokošný²,

Wohlfahrt³

et al. 2013

Exp Clin Transplant

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“…Transplant centers that request OPOs to release kidneys for dual transplantation are sometimes met with resistance from the OPO either because the OPO personnel believe the kidneys can be placed as singles or the kidneys do not meet UNOS criteria for dual allocation. Given evidence that UNOS criteria does not adequately identify ECD kidneys that would confer a graft survival advantage if transplanted as dual (15), more discriminating allocation criteria are needed. Allocation of kidneys with KDRI >2.2 should be considered as an option for dual placement, not only because the already poor outcomes can be improved with dual transplantation, but organ utilization may also improve particularly if more efficient placement is employed.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, UNOS criteria do not adequately identify ECD kidneys that would confer a graft survival advantage if transplanted as dual (15).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Adult Dual Kidney Transplants by KDRI in the United States

Klair

Gregg

Phair

et al. 2013

American Journal of Transplantation

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UNOS guidelines provide inadequate discriminatory criteria for kidneys that should be transplanted as single (SKT) versus dual (DKT). We evaluated the utility of the kidney donor risk index (KDRI) to define kidneys with better outcomes when transplanted as dual. Using SRTR data from 1995 to 2010 of de novo KTX recipients of adult deceased-donor kidneys, we examined outcomes of SKT and DKT stratified by KDRI group 1.4 (n ¼ 49 294), 1.41-1.8 (n ¼ 15 674), 1.81-2.2 (n ¼ 6523) and >2.2 (n ¼ 2791). DKT of kidneys with KDRI >2.2 was associated with significantly better overall graft survival [adjusted hazard ratio (aHR) 0.83, 95% confidence interval (CI) 0.72-0.96] compared to single kidneys with KDRI >2.2. DKT was associated with significantly decreased odds of delayed graft function (top 2 KDRI categories) and significantly decreased odds of 1-year serum creatinine level >2 mg/dL (top 3 KDRI categories). Among SKT and DKT from KDRI >2.2 there were 16.1 and 13.9 graft losses per 100 patient follow-up years, respectively. KDRI >2.2 is a useful discriminatory cut-off for the determination of graft survival benefit with the use of DKT; however, the benefit of increased graft years was less than half of single kidneys from donors in the same KDRI range.

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“…There was no urine leakage occurred in this series. In single kidney transplant, the incidence of urological complications was reported from 3.6 to 5.8 % [12][13][14].…”

Section: Edkt (N=2) Udkt (N=7) Bdkt (N=1) Totalmentioning

confidence: 99%

Dual Kidney Transplant: Clinical Experience and Overview of Surgical Techniques

He¹

2015

J Surg Surgical Res

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Background: Dual Kidney Transplant (DKT) of marginal kidneys has expanded utilizing the extended criteria donor (ECD) organs. The aim of this study is to report the outcomes of dual kidney transplant in our institute and review the surgical techniques of DKT in the Literature. Materials and Methods:Between Jan 1999 and April 2014, 10 cases (8 male and 2 female; mean age 50 years) of DKT were performed in our institute. The surgical techniques include unilateral incision for 9 patients, a midline incision for 1 patient. The literature was reviewed for surgical techniques of DKT.Results: Two recipients had DKT as an En bloc from pediatric donors, whereas others had DKT from elderly donors. The mean surgical time was 5 hours 4 min (Range: 3 hours 40 min to 6 hours 24 min). Two patients had a complication of lymphocele and subsequent development of ureteric stricture. There was no vessel thrombosis and no urine leakage in this cohort. The creatinine level was 137 (± 37.4) µmol/L at 12 months follow-up. The various techniques were described in the literature. Conclusion:DKT is an established technique for expanding use of extended criteria of kidney donors. The clinical outcome is satisfactory and surgical complications can be minimized. Based on our experience in a small series, vascular complication can be prevented with caution during vessel anastomosis and position of the kidney grafts. The single site placement of DKT is preferred from the literature review.

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

Cited by 86 publications

References 21 publications

Dual Kidney Transplant: A Single-Center Experience and Review of the Literature

Dual Kidney Transplant: A Single-Center Experience and Review of the Literature

Outcomes of Adult Dual Kidney Transplants by KDRI in the United States

Dual Kidney Transplant: Clinical Experience and Overview of Surgical Techniques

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