Single versus dual renal transplantation from donors with significant arteriosclerosis on pre-implant biopsy
Article first published online: 23 DEC 2008
© 2008 Wiley Periodicals, Inc.
Volume 23, Issue 4, pages 525–531, August/September 2009
How to Cite
Kayler, L. K., Mohanka, R., Basu, A., Shapiro, R. and Randhawa, P. S. (2009), Single versus dual renal transplantation from donors with significant arteriosclerosis on pre-implant biopsy. Clinical Transplantation, 23: 525–531. doi: 10.1111/j.1399-0012.2008.00925.x
- Issue published online: 28 JUL 2009
- Article first published online: 23 DEC 2008
- Accepted for publication 7 October 2008
- donor biopsy;
- kidney transplant;
Abstract: Background: Transplantation of kidneys from donor with arteriosclerosis seen on pre-implantation biopsy has not been well studied.
Methods: We retrospectively evaluated 20 dual kidney transplant (DKT) and 28 single (SKT) kidney transplant recipients with ≥12 months follow-up from donors with moderate arteriosclerosis (≥25% luminal diameter narrowing).
Results: Death censored graft survival was 100% and 79%, respectively (p = 0.0339). DKT recipients had significantly lower mean creatinine levels at one, three, six, and nine months and spent somewhat less time on the waiting list (181 ± 160 vs. 318 ± 306 d, p = 0.1429). DKT patients received kidneys from significantly older donors (64 ± 7 vs. 54 ± 11 yr; p = 0.0012), proportionately more expanded criteria donors (95% vs. 54%; p = 0.0029), and more donors with hypertension (81% vs. 48%, p = 0.0344) and death related to cerebrovascular accident (100% vs. 71%, p = 0.0143); however, more DKT kidneys underwent machine perfusion (95% vs. 57%, p = 0.0068). Baseline recipient variables were comparable between the two groups including age, race, gender, retransplantation, and HLA mismatch. Pre-implant biopsy was notable for similar frequencies of moderate interstitial fibrosis (10% vs. 14%, respectively) and glomerulosclerosis.
Conclusion: Among recipients of deceased-donor kidneys with >25% arteriosclerosis, short-term outcomes after DKT were superior to that of SKT grafts. This approach may help to expand the donor-organ pool while optimizing outcomes.