Technical Aspects of Unilateral Dual Kidney Transplantation from Expanded Criteria Donors: Experience of 100 Patients

Abstract

One option for using organs from donors with a suboptimal nephron mass, e.g. expanded criteria donors (ECD) kidneys, is dual kidney transplantation (DKT). In adult recipients, DKT can be carried out by several techniques, but the unilateral placement of both kidneys (UDKT) offers the advantages of single surgical access and shorter operating time. One hundred UDKT were performed using kidneys from ECD donors with a mean age of 72 years (Group 1). The technique consists of transplanting both kidneys extraperitoneally in the same iliac fossa. The results were compared with a cohort of single kidney transplants (SKT) performed with the same selection criteria in the same study period (Group 2, n = 73). Ninety-five percent of UDKTs were positioned in the right iliac fossa, lengthening the right renal vein with an inferior vena cava patch. In 69% of cases, all anastomoses were to the external iliac vessels end-to-side. Surgical complications were comparable in both groups. At 3-year follow-up, patient and graft survival rates were 95.6 and 90.9% in Group 1, respectively. UDKT can be carried out with comparable surgical complication rates as SKT, leaving the contralateral iliac fossa untouched and giving elderly recipients a better chance of receiving a transplant, with optimal results up to 3-years follow-up.

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

“…However, all previously described DKT techniques with standard vascular and ureteral anastomoses have been associated with significantly higher rates of early renal graft thrombosis, but similar rates of lymphocele, urinary tract fistula, and wound infection compared to SKTs. 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.…”

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

“…Selection of optimal candidates is important in DKT because it is a more extensive procedure and is typically performed in elderly recipients which have less physiologic reserve than younger recipients. Despite the greater extent of the DKT procedure, complication rates have been shown to be comparable to those of single kidney transplants (13).…”

“…Concerns over the limited life span of marginal kidneys have led some surgeons to perform dual kidney transplantation based on the concept that poor long-term outcomes may be the consequence of an imbalance between the number of viable nephrons supplied and the metabolic demand of the recipient (1); therefore, concurrent transplantation of two kidneys into one recipient would increase nephron dosing (2) and maximize outcomes (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…Criteria or scoring systems for choosing to perform dual transplantation have generally included older donor age and one or more other parameter(s) such as preimplant biopsy, donor estimated creatinine clearance, kidney weight, machine perfusion characteristics and/or long cold ischemia time (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). However, it is not always clear whether the criteria utilized is robust enough to select which marginal donor kidneys should be used together in order to maximize successful outcomes without reducing the organ supplythat is by dual grafting when a single graft would suffice.…”

Dual Kidney Transplant: Clinical Experience and Overview of Surgical Techniques

“…The patient recovered well without any surgical complication. In addition, En bloc transplant at unilateral side is in favour using aorta and vena cava for vessel anastomosis [19].…”