Multicenter Study on Double Kidney Transplantation

• Published in: Transplantation proceedings 2008-07, Vol.40 (6), p.1869-1870
• Main Authors: Bertelli, R, Nardo, B, Capocasale, E, Cappelli, G, Cavallari, G, Mazzoni, M.P, Benozzi, L, Dalla Valle, R, Fuga, G, Busi, N, Gilioli, C, Albertazzi, A, Stefoni, S, Pinna, A.D, Faenza, A
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Follow-Up Studies; Functional Laterality; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Histocompatibility Testing; Humans; Kidney Diseases - classification; Kidney Diseases - surgery; Kidney Transplantation - immunology; Kidney Transplantation - methods; Kidneys; Malformations of the urinary system; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Patient Selection; Postoperative Complications - classification; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue, organ and graft immunology; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.05.025

Abstract Background Marginal organs not suitable for single kidney transplantation are considered for double kidney transplantation (DKT). Herein we have reviewed short and long-term outcomes of DKT over a 7-year experience. Patients and Methods Between 2001 and 2007, 80 DKT were performed in the transplant centers of Bologna, Parma, and Modena, Italy. Recipient mean age was 61 ± 5 years. The main indications were glomerular nephropathy (n = 33) and hypertensive nephroangiosclerosis (n = 14). Mean HLA A, B, and DR mismatches were 3.1 ± 1.2. Donor mean age was 69 ± 8 years and mean creatinine clearance was 75 ± 27 mL/min. Almost all kidneys were perfused with Celsior solution. Mean cold ischemia time was 17 ± 4 hours and mean warm ischemia time was 41 ± 17 minutes. Mean biopsy score was 4.4. Immunosuppression was based on tacrolimus (n = 52) or cyclosporine (n = 26). Results Fifty (62.5%) patients displayed good postoperative renal function. Thirty (37.5%) experienced acute tubular necrosis and required postoperative dialysis treatment; 8 acute rejections occurred. Urinary complications were 13.7% with 8/11 requiring surgical revision. There were 6 surgical reexplorations: intestinal perforation (n = 2), bleeding (n = 3), and lymphocele (n = 1). Two patients lost both grafts due to vascular and infectious complications at 7 or 58 days after transplantation. Two patients underwent intraoperative transplantectomy due to massive vascular thrombosis. Four (5%) patients underwent transplantectomy of a single graft due to vascular complications (n = 2), bleeding (n = 1), or infectious complications (n = 1). Graft and patient survivals were 95% and 100% versus 93% and 97% at 3 versus 36 months, respectively. Conclusions DKT is a safe approach for organ shortage. The score used in this study is useful to determine whether a kidney should be refused or accepted.