Single graft loss in dual renal transplant recipients: impact of graft placement on recipient outcomes

Abstract

Summary We aimed to assess the impact of graft placement in dual renal transplantation on the risk for single graft loss and to report recipient outcomes. Between 2004 and 2007, 55 dual renal transplants were performed at our institution. Allografts were placed bilaterally (one in each iliac fossa) in 42 patients and unilaterally (both in the same iliac fossa) in 14 patients. Nine recipients (16.4%) underwent explantation of a single graft as a consequence of vascular thrombosis designated as the SINGLE group, whereas 46 had two functional allografts (DUAL group). There was a higher rate of graft loss in case of unilateral placement (n = 5/14) compared with bilateral placement (n = 4/41) (35.7% vs. 9.8%, P = 0.035). One‐year glomerular filtration rate was significantly lower in the SINGLE group (29.4 ml/min/1.73 m2 vs. 49.4 ml/min/1.73 m2 in the DUAL group, P < 0.05). Significantly, none of the nine recipients of the SINGLE group returned to dialysis with a mean follow‐up of 34.1 months. Graft survival at 1 year was 100% and 97.9% in SINGLE and DUAL groups, respectively. Unilateral placement of both allografts is associated with an increased risk of single graft loss and therefore lower renal function at 1 year. However, this strategy is safe in selected indications.

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

“…In a recent prospective study, Snanoudj and associates 10 found that a donor eGFR between 0.5 and 1.0 mL/s was easily applicable to allocate ECD kidneys from donors over 65 years of age for a DKT. This finding also was confirmed by Timsit and associates, 11 in which kidneys with an eGFR of 0.5 to 1.0 mL/s from ECD donors were used for DKTs.…”

“…17 In the study by Ekser and associates 24 with 100 unilateral DKTs, the authors reported surgical complication rates comparable to those of SKTs. On the other hand, in a recent study by Timsit and associates, 11 unilateral placement of both allografts was associated with an increased risk of single graft loss.…”

Dual kidney transplant techniques: A systematic review

“…Remuzzi did not specify how the urinary reconstruction was performed . De Serres, Timsit, and Lee used the external iliac vessels, and De Serres and Lee performed extravesical ureteroneocystostomies, whereas Timsit performed pyeloureterostomy . Rigotti did not specify to which vessels the renal artery and vein were anastomosed, nor were details regarding the urinary reconstruction provided …”

“…Ekser and Veroux both placed the right kidney superiorly as its vein can be lengthened by a segment of IVC . Timsit performed a ureteroneocystostomy with the ureter of the lower graft, whereas both Veroux and Gaber performed a conjoined technique and Ekser performed separate ureteroneocystostomies …”

“…Within the unilateral placement with separate anastomoses studies, overall 2‐year patient survival was 96.7%. It should be noted that Timsit's paper included two groups of patients with different surgical techniques for whom survival was not separately calculated and was 98.1% overall at 1 year . One of the two studies of patients with unilateral placement and patch anastomoses reported patient survival (100% at 1 year and 90% at 1 years—Veroux) .…”