Dual Kidney Transplantation: Single-Center Experience |
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| Affiliation: | 1. Departamento de Nefrologia, Centro Hospitalar do Médio Tejo, Torres Novas, Portugal;2. Departamento de Nefrologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal;3. Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal;4. Serviço de Urologia e Transplantação Renal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal;1. Paulista School of Nursing, Federal University of São Paulo, São Paulo, Brazil;2. Nursing Department, Federal University of Santa Catarina, Florianópolis, Brazil;3. Nursing School, Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil;4. State Transplant Center, Secretary of Health of the State of São Paulo, São Paulo, Brazil;5. Health Department, Vale dos Sinos University, Porto Alegre, Brazil;1. Ribeirão Preto Medical School at University of São Paulo (FMRP/USP), Ribeirão Preto, SP, Brazil;2. Human Tissue Bank of Hospital das Clínicas, Ribeirão Preto Medical School at University of São Paulo (FMRP/USP), Ribeirão Preto, SP, Brazil;3. Ribeirão Preto College of Nursing at University of São Paulo (EERP/USP), Ribeirão Preto, SP, Brazil;4. Estácio University Center of Ribeirão Preto, Ribeirão Preto, SP, Brazil;1. Department of Nephrology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal;2. Department of Nephrology, Centro Hospitalar Universitário do Porto, Porto, Portugal;3. Department of Nephrology, Hospital do Espírito Santo de Évora, Évora, Portugal;4. Department of Nephrology, Hospital de Braga, Braga, Portugal;5. Department of Nephrology, Hospital Garcia da Orta, Almada, Portugal;6. Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal;1. Portuguese Society of Transplantation;2. NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal;3. Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal;4. 16th Portuguese Congress of Transplantation;5. 20th Luso Brazilian Congress of Transplantation;6. Department of Medicine and Transplantation, Centro Hospitalar Universitário de Lisboa Central, Lisboa Central;1. Nephrology Department, Centro Hospitalar de Santo António, Porto, Portugal;2. Nephrology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal;3. Nephrology Department, Hospital Espírito Santo de Évora, Évora, Portugal;4. Nephrology Department, Hospital de Braga, Braga, Portugal;5. Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal |
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| Abstract: | ![]()
BackgroundDual and en bloc kidney transplantation are strategies used to mitigate the disparity between a reduced organ pool and an ever-increasing need for organ procurement. En bloc refers to the implantation of 2 kidneys from a pediatric donor, compensating for small renal mass, whereas dual expanded criteria donor (DECD) transplantation refers to older donors with grafts otherwise rejected for single transplant, including expanded. This study describes one center's experience with dual and en bloc transplantation.MethodsA retrospective cohort study of dual kidney transplants (en bloc and DECD) from 1990 through 2021. The analysis included demographic, clinical, and survival analysis.ResultsOf 46 patients who underwent dual kidney transplantation, 17 (37 %) received en-bloc transplantation. The overall mean recipient age was 49.4 ± 13.9 years old, younger in the en-bloc subgroup (39.2 vs 59.8 years old, P < .01). The mean time on dialysis was 37 ± 25 months. Delayed graft function was present in 17.4 % and primary nonfunction in 6.4 %, all from the DECD group. The estimated glomerular filtration rates at 1 and 5 years were 76.7 ± 28.7 and 80.4 ± 24.8 mL/min/1.73 m2, lower in the DECD group (65.9 vs 88.7 mL/min/1.73 m2, P = 0.02). Eleven recipients lost their graft during the study period: 63.6% from death with a functioning graft, 27.3% due to chronic graft dysfunction (a mean of 76.3 months after transplantation), and 9.1% due to vascular complications. Subgroup comparison found no differences regarding cold ischemia time or length of hospitalization. Kaplan-Meier estimates, censored for death with a functioning graft, resulted in a mean graft survival of 21.3 ± 1.3 years, with survival rates of 93.5, 90.5, and 84.1% at 1, 5, and 10 years, respectively, without significant differences between subgroups.ConclusionsBoth DECD and en bloc strategies provide safe and effective options to further expand the use of otherwise rejected kidneys. Neither of the 2 techniques was superior to the other. |
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