Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom

Abstract

Background and objectivesKidneys from elderly deceased donors are often discarded after procurement if the expected outcomes from single kidney transplantation are considered unacceptable. An alternative is to consider them for dual kidney transplantation. We aimed to examine the utilization of kidneys from donors aged ≥60 years in the United Kingdom and compare clinical outcomes of dual versus single kidney transplant recipients.Design, setting, participants, & measurementsData from the United Kingdom Transplant Registry from 2005 to 2017 were analyzed. We examined utilization rates of kidneys retrieved from deceased donors aged ≥60 years, and 5-year patient and death-censored graft survival of recipients of dual and single kidney transplants. Secondary outcomes included eGFR. Multivariable analyses and propensity score analysis were used to correct for differences between the groups.ResultsDuring the study period, 7841 kidneys were procured from deceased donors aged ≥60 years, of which 1338 (17%) were discarded; 356 dual and 5032 single kidneys were transplanted. Donors of dual transplants were older (median, 73 versus 66 years; P<0.001) and had higher United States Kidney Donor Risk Indices (2.48 versus 1.98; P<0.001). Recipients of dual transplants were also older (64 versus 61 years; P<0.001) and had less favorable human leukocyte antigen matching (P<0.001). After adjusting for confounders, dual and single transplants had similar 5-year graft survival (hazard ratio, 0.81; 95% CI, 0.59 to 1.12). No difference in patient survival was demonstrated. Similar findings were observed in a matched cohort with a propensity score analysis method. Median 12-month eGFR was significantly higher in the dual kidney transplant group (40 versus 36 ml/min per 1.73 m2; P<0.001).ConclusionsRecipients of kidneys from donors aged ≥60 years have similar 5-year graft survival and better graft function at 12 months with dual compared with single deceased donor kidney transplants.

Organ donation and transplantation: a multi-stakeholder call to action

“…For patients with kidney failure, these organs can improve survival compared with remaining on dialysis 67 . Dual kidney transplantation (whereby both kidneys from a donor are transplanted into a recipient) can also allow the use of organs from marginal (for example, older) donors 68 .…”

Dual kidney transplants from adult marginal donors: Review and perspective

“…158,172,[192][193][194] Centers in France, Germany, and the United Kingdom have likewise provided important contributions to the world experience in DKT including the use of alternative scoring systems and expansion with DCD donor kidneys. 51,65,81,82,84,96,[113][114][115]117,118,125,127,135,144 In addition, centers in Ireland, Canada, Australia, Czech Republic, the Middle East, and…”

“…DDs with marginal renal functional capacity represent a large proportion of potential kidneys doomed to discard or non‐recovery 7,10,11,33,110,148–175 . One approach to offset this dilemma has been the greater application of DKT from adult MDDs 35–145 . There have been several excellent recent reviews focusing on various aspects of DKT 72,118,127,129,130,138,142 .…”

Staggered Dual Kidney Transplantation

“…Outcomes after dual kidney transplantations have been shown to be similar or better at 1- and 5-years postoperatively compared to single grafts. 3…”

“…Outcomes after dual kidney transplantations have been shown to be similar or better at 1-and 5-years postoperatively compared to single grafts. 3 We describe a scenario where a patient received an otherwise discarded second kidney in a staggered fashion. The decision for a staggered dual evolved due to a combination of clinical reasons in the primary intended recipients and logistical delays.…”