Single Kidney Transplantation Research Articles

Single kidney transplantation from donors with acute kidney injury: A single‐center experience

Despite a severe shortage of organ supply, patients are reluctant to accept organs from deceased donors with AKI, let alone from pediatric AKI donors. We assessed 70 patients who received kidneys from donors with AKI (10 with pediatric and 60 with adult donors) and 176 contemporaneous patients who received kidneys from non-AKI donors (41 with pediatric and 135 with adult donors) between March 2012 and February 2017 for retrospectively evaluating the clinical outcomes. AKI was defined and staging by the RIFLE criteria and pediatric-modified RIFLE criteria. Median age was 11.00years IQR (4.50-14.00years), and median weight was 25.00kg (IQR, 17.00-45.00kg) for all pediatric donors. Median follow-up was 8months (range, 1-49months). Adult AKI group had the highest incidence of DGF (35.0% vs 10%, 9.8%, and 19.3%, P=0.011). There was a significant increase in DGF in higher AKI stages (Risk: 20.7%, Injury: 46.7%, Failure: 50.0%; P=0.014) among patients with adult donors. No significant differences were noted in 1-year (100.0%, 95.1%, 98.3%, and 97.8%; P=0.751) and 3-year (100.0%, 95.1%, 98.3%, and 97.8%; P=0.751) patient survival, and 1-year (90.0%, 97.6%, 98.3%, and 95.6%; P=0.535) and 3-year (90.0%, 97.6%, 98.3%, and 95.6%; P=0.535) graft survival. Transplants procured from donors with AKI, particularly pediatric ones, could achieve excellent intermediate-term clinical outcomes and thus potentially expand the donor pool.

Chronic histological changes in deceased donor kidneys at implantation do not predict graft survival: a single-centre retrospective analysis.

The use of preimplantation kidney biopsies (PIKBs) to aid deceased donor kidney utilization decisions is controversial. Outcomes of transplants that had been biopsied after the decision had been made to implant were analysed, in order to determine the association between chronic histological changes at implantation and graft outcomes. A retrospective analysis of transplants between the year range 2006-2015 was performed. Karpinski scores on biopsies were collected, and graft outcomes were analysed using univariate and multivariable techniques. Also, Karpinski scores from single and dual kidney transplants from older donors were examined to determine if knowledge of the score preoperatively would have altered utilization. Four hundred and eight single kidneys were transplanted. Although kidneys with scores >4 had lower 1- and 3-year median (IQR) estimated glomerular filtration rates (eGFRs) than those scoring 0-4 (51 (37-66) vs. 35 (26-52) ml/min/1.73m2 , P<0.001, and 52 (34-64) vs. 35 (24-52) ml/min/1.73m2 , P<0.001, respectively), there was no significant association between Karpinski score and death-censored graft survival on univariate or multivariable analyses. The utilization analysis (75 single and 25 dual kidney transplant recipients) suggested that systematic use of PIKBs would have resulted in 29% fewer patients being transplanted. This analysis does not support the systematic use of PIKBs to determine deceased donor kidney utilization.

The Promise of Single Kidney Transplants from Small Pediatric Donors

The Promise of Single Kidney Transplants from Small Pediatric Donors

Trends and outcomes in dual kidney transplantation- A narrative review.

Dual kidney transplantation (DKT) is a viable option to increase the donor pool and improve access equity to kidney transplantation. Dual kidneys are procured from carefully selected marginal donors that are not generally acceptable to most transplant centers. This is a narrative review of literature focusing on donor kidney allocation systems and selection of the ideal recipient for DKT. We also discussed surgical approaches for DKTs as well as patient and allograft outcomes. We found that most studies to date showed that DKTs has similar graft survival and delayed graft function rates when compared to single kidney transplants (SKTs). DKT is technically feasible with outcomes that are comparable to expanded criteria donor kidneys (ECD); and has substantial potential in expanding the donor pool. For allograft survival, most studies with strict allocation criteria showed that graft survival was similar in DKT as compared to SKT - ECD transplants.. Our review may encourage transplant centers to review their policies for donor and recipient selection leading to increase in DKT.

Dual Kidney Transplantation from Donors at the Extremes of Age

The study purpose was to analyze outcomes in recipients of pediatric dual en bloc (PEB) kidneys from small pediatric donors (SPDs, age ≤ 3 years) and dual kidney transplants (KTs) from adult marginal deceased donors (DDs) in the context of the Kidney Donor Profile Index (KDPI). This was a single center retrospective review. Recipient selection included primary transplant, low BMI, low immunologic risk, and informed consent. All patients received antibody induction with FK/MPA/± prednisone. From 2002 to 2015, we performed 34 PEB and 73 adult dual KTs. Mean donor ages were 17months for the PEB and 59 years for the dual KTs; mean KDPIs were 73% for PEB and 83% for dual KT, and mean cold ischemia times were 21.0 hours for PEB and 26.5 hours for dual KT. Adult dual KT recipients were older (mean age 38 years for PEB and 60 years for dual KT) and had shorter waiting times (mean 25 months for PEB and 12 months for dual KT). With a mean follow-up of 7.6 years, actual patient survival (88% for PEB and 62% for dual KT) and graft survival (71% for PEB and 44% for dual KT) rates were higher in PEB compared with dual KT. Death-censored kidney graft survival rates were 77% for PEB and 58% for dual KT. Delayed graft function (DGF) rates were 15% for PEB and 23% for dual KT; incidences of DGF in single kidney transplantations from SPDs and adult nonmarginal DDs were 20% and 32%, respectively. Based on actual 5-year graft survival rates, the adjusted KDPIs for dual PEB and dual KTs were 3% and 60%, respectively. Acceptable mid-term outcomes are associated with PEB and adult dual KTs, which may expand the donor pool and prevent kidney discard. The KDPI is inaccurate for predicting outcomes from either PEB from SPDs or dual KT from adult marginal DDs, which may prevent acceptance of these organs.

Re: Safety of Dual Kidney Transplantation Compared to Single Kidney Transplantation from Expanded Criteria Donors: A Single Center Cohort Study of 39 Recipients

Re: Safety of Dual Kidney Transplantation Compared to Single Kidney Transplantation from Expanded Criteria Donors: A Single Center Cohort Study of 39 Recipients

Impact of Donor Age on Clinical Outcomes of Primary Single Kidney Transplantation From Maastricht Category-III Donors After Circulatory Death.

BackgroundStandard-criteria donation after circulatory death (DCD) kidney transplants (KTx) have higher primary nonfunction, delayed graft function (DGF), and rejection rates than age-matched donation after brain death (DBD) but similar graft survival. Data on expanded-criteria DCD are conflicting and many centers remain concerned regarding their use.MethodsIn this single-center observational study with 5-year follow-up, we analyzed data from 112 primary DCD Maastricht category-III single KTx receiving similar organ preservation and maintenance immunosuppression. Patients were sorted as young DCD (donor <60 years, 72 recipients) or old DCD (donor ≥60 years, 40 recipients). Old DCD outcomes were compared with young DCD and to a DBD control group (old DBD, donor ≥60 years, 40 recipients).ResultsAfter 5 years, old DCD showed lower patient survival (66% vs 85%; P = 0.014), death-censored graft survival (63% vs 83%; P = 0.001), and Modification of Diet in Renal Disease estimated glomerular filtration rate (34, 27.0-42.0 mL/min per 1.73 m2 vs 45.0, 33.0-58.0 mL/min per 1.73 m2; P = 0.021) than young DCD with higher DGF (70% vs 47.2%; P = 0.029) and graft thrombosis (12.5% vs 1.4%; P = 0.021). Comparison between old DCD and old DBD showed similar 5-year patient survival (66% vs 67%; P = 0.394) and death-censored graft survival (63% vs 69%; P = 0.518) but higher DGF (70% vs 37.5%; P = 0.007) and lower estimated glomerular filtration rate (34, 27.0-42.0 mL/min per 1.73 m2 vs 41, 40.0-42.0 mL/min per 1.73 m2; P = 0.029). Multivariate Cox regression analysis showed that donor 60 years or older (hazard ratio, 3.135; 95% confidence interval, 1.716-5.729; P < 0.001) and induction with anti–IL2-receptor-α monoclonal antibody (hazard ratio, 0.503; 95% confidence interval, 0.269-0.940, P = 0.031 in favor of induction with rabbit antithymocyte globulin) are independent predictors of transplant loss.ConclusionsOverall, single KTx from DCD Maastricht category-III donors 60 years or older have inferior outcomes than KTx from donors younger than 60 years. Comparison with age-matched DBD showed similar patient and graft survivals. However, the discrepancy in graft function between DCD and DBD deserves further investigation.

Il trapianto renale da cadavere: valutazione di idoneità del donatore e del rene

Kidney transplantation is the optimal treatment for selected patients with end-stage kidney failure. However, the demand for kidney transplantation exceeds the supply of organs available. At the beginning of the twenty-first century, in an attempt to increase the pool of deceased donor organs and reduce organ discard rates, kidney transplant programs have been developed using Expanded Criteria Donor kidneys, for Single or Dual Kidney Transplantation, and kidneys from Donation after Circulatory Death. Moreover, for appropriately selected candidates, are now offered organs from donors with increased but “acceptable” risk profile for the transmission of infectious and neoplastic diseases. Based on this reality, to date, the assessment of eligibility for a deceased donor to kidney transplantation is complex and requires a multidisciplinary approach through each step of the donation process. In this review, we outline the various modalities of kidney transplantation from a deceased donor. We also report the eligibility criteria based on the donor profile for diseases transmissible to the recipient, and the scores based on donor characteristics and histology criteria from kidney biopsies that are currently used to refine the quality of organs used for transplantation.

Preliminary experience of sequential use of normothermic and hypothermic oxygenated perfusion for donation after circulatory death kidney with warm ischemia time over the conventional criteria - a retrospective and observational study.

Donation after circulatory death (DCD) is a potential source of reducing organ demand. In Italy, DCD requires a 20-min no-touch period that prolongs warm ischemia and increases delayed graft function (DGF) risk and graft loss. We report here our preliminary experience of sequential use of normothermic regional perfusion (NRP), as standard procedure, and hypothermic oxygenated perfusion (HOPE), as an experimental technique of organ preservation, in 10 kidney transplants (KT) from five DCD Maastricht III with extensive functional warm ischemia time (fWIT) up to 325 min. During NRP, renal function tests were evaluated to accept organs which were retrieved according to standard fashion with biopsy. While waiting for pathology and cross-match results, organs were preserved with HOPE through pressure- and temperature-controlled arterial pulsatile flow. All grafts with Karpinski score ≤4 were used for conventional single KT with mean cold ischemia time of 584 ± 167 min and mean fWIT of 151 ± 132 min. At the end of HOPE, lactate levels increased significantly in all cases with DGF (P = 0.0095), which were 3/10 (30%). No primary nonfunctions were recorded, and all patients had sCr < 1.5 mg/dl at 6-month post-KT. NRP and HOPE for DCD may overcome fWIT limits safely, and lactate during HOPE predicts DGF.

Pre-Transplant Histological Assessment Provides a Useful Predictor of Subsequent Kidney Allograft Function

Introduction Organ shortage is a major challenge in transplantation. In view of this problem, organs from marginal donors are increasingly being considered for transplantation. In kidney transplantation, histological assessment of deceased donor kidneys with the Remuzzi score (RS) has proven to be effective at predicting renal allograft survival but requires further validation. Addenbrookes Hospital in Cambridge, UK, has used RSs to determine suitability of deceased donor kidneys from older donors and those with multiple co-morbidities, for single or dual transplantation. From 2010, kidneys with a RS of 1-3 were deemed suitable for single kidney transplantation, and in 2014 this was extended to include kidneys with a RS of 4. We sought to assess the efficacy of the RS to predict kidney transplant outcomes and to confirm that single kidneys transplanted with RS of 4 had reasonable outcomes. Methods All recipients of single deceased donor kidney transplants performed at Addenbrookes hospital, Cambridge, with available pre-transplant RSs, between 2010 and 2016 were identified. Transplant outcomes (death censored graft survival and 1 year eGFR) were analysed. Results In total, 495 single deceased donor kidneys with RSs were identified. Of these 40.2% were from donation after brain stem death donors (DBD), and 59.8% were from donation after circulatory death donors (DCD). The breakdown of the RS of these kidneys are shown in figure 1. The 1 year eGFR and graft survivals according to their RS are shown in Table 1. 1 year death censored graft survival was not negatively impacted by higher pre-donation RS (p=0.54). However, graft function at 1 year was significantly worse with a RS ≥ 5, median eGFR 41.9 ml/min (95% CI 34.3-49.5) versus 52.3 ml/min (95% CI 49.8-54.7) with a score <5 (p=0.02) (figure 2). Increasing RS conferred reductions in 1 year eGFR (r=-0.356, p<0.01). Discussion This single centre, retrospective observational study demonstrates that the RS is effective in predicting deceased donor renal allograft function at one year. The data also shows that selected kidneys with a RS>5 have reasonable transplant outcomes. These results highlight the need for additional indicators to improve prediction of post-transplant renal function. We developed a model to highlight if any of the individual parameters were more predictive of 1 year eGFR in this cohort, but they were not. However this was with a small cohort and we are collecting additional data to better power this analysis. Furthermore we are currently looking biomarkers which may be predictive of functional outcomes, using transcriptomics on these biopsy samples.

Clinical Observation of Single Kidney Transplantation for Adult Recipients from Non-Heartbeating Pediatric Donors

Objective To investigate the early clinical effect of single kidney transplantation for adult recipients from non-heartbeating pediatric donors(<12y),comparing with single renal transplantation from adult kidney donor. Methods A retrospective review of clinical data of donors and recipients kidney transplantation from donation after deceased cardiac donors (DCD) performed from November 2013 to June 2017 in kidney transplantation department of the first affiliated hospital of Xi’an Jiaotong university. There were three groups divided by the long axis of the kidney:<6cm(8); 6-8cm(18); >8cm(30). Postoperative blood pressure, urinary protein, renal function of 50 recipients were monitored tightly. Results The long axis of the kidney before and after opening blood flow were 7.53±1.13cm and 8.48±1.10cm totally. Recipients’ blood pressure were held during 110/60 to 140/100mmHg and weight were 40-60kg. Respectively, renal function of there groups recovered(serum creatinine<177μmol/L) in 6.4±3.3, 10.6±2.4, 18.6±5.8 days. Disappearance of proteinuria were markedly correlated with control of postoperative blood pressure and donor renals size. Kidney volume increases significantly within one month after surgery and long axis of the kidney will be more than 10 cm after half a year. Conclusions Short-term out-comes of single kidney transplantation from pediatric donors seemed a little worse than adult donors. It mainly manifested in less urine, strict blood pressure control, long time proteinuria and more complications. So, we believe non-heartbeating pediatric donors is available resources, but recipients’ systolic pressure must be control about 120mmHg and proteinuria and renal function should be strict monitored, especially in the long axis of the kidney less than 6cm. It maybe relative to damage of the glomerular basement membrane. A further study is needed for the electron microscope. Key words: non-heartbeating pediatric donors; kidney transplantation; blood pressure; proteinuria

Kidney Transplantation in Elderly Recipients: A Single-Center Experience

In this retrospective single-center study we evaluated the outcome after kidney transplant in recipients older than 65 years in terms of patient and graft survival and causes of death. Patients and MethodsFrom 1993 to 2016, 109 consecutive first single kidney transplants in recipients older than 65 years were included. Furthermore, 2 age groups have also been identified (group A, 65–70 years old vs group B, 71–76 years old).Donor and recipient characteristics were analyzed. Other parameters were cold and warm ischemia times, delayed graft function, biopsy-proven acute rejection, and causes of death.Induction immunosuppressive therapy was performed with basiliximab or thymoglobulin. Baseline triple immunosuppression included calcineurin inhibitor, antimetabolite, and steroids.The results of preimplantation biopsies, which were performed in all expanded criteria donors were analyzed and graded according to Karpinski 2009 classification. ResultsOverall mortality was 39.4%: 23.2% women and 76.8% men. Causes of death were infections in 42%, tumors in 23%, cardiovascular disease in 14%, cerebrovascular disease in 7%, and unknown in 14%. The most common cause of death in men was infections (52%), and the most common cause in women was tumors (55%).At 1, 3, 5, and 10 years, overall patient survival was 89%, 84%, 72%, and 45%, and overall graft survival was 100%, 97%, 89%, and 84%, respectively. Patient and graft survival were statistically different between group A vs group B (P = .006 and P = .02, respectively). At univariate analysis significant risk factors for increased mortality were age, delayed graft function, and cold ischemia time. At multivariate analysis, delayed graft function maintained statistical significance. ConclusionsKidney transplantation in patients older than 65 years is safe, feasible, and has good graft survival. Mortality is statistically significant in patients older than 71 years, despite a persistent low graft loss.

Long-term outcomes of en-bloc renal transplantation from paediatric donors into adult recipients

IntroductionTransplant units are exploring strategies to increase the availability of donor kidneys. The use of en-bloc kidney transplantation (EBKT) from paediatric donors represents one potential solution. We present our long-term experience with paediatric EBKT among adult recipients. MethodsTwenty-three paediatric to adult EBKTs were performed by the Irish National Kidney Transplant Service between 1990 and 2016. The primary outcome variable was long-term en-bloc allograft survival rate. Secondary outcome variables were incidence of allograft thrombosis, incidence of delayed graft function, overall patient survival and serum creatinine at most recent follow-up. Outcomes were compared to single kidney transplant recipients from the same time period. ResultsMean donor age was 1.8 ± 0.97 years (range: 7 months to 3 years). Recipient age was 46 ± 12 years. Mean follow-up was 133 ± 64 months (range: 36–264). Overall graft survival was 100%, 91% and 80% after 1, 5 and 10 years respectively, compared to 92%, 79% and 61% in single kidney transplant recipients (p = 0.04). There were 5 cases of allograft failure, 3 due to death from unrelated causes. Median time to graft failure was 108 months (range: 36–172). Mean serum creatinine was 72.6 ± 21.6 μmol/l after the follow-up period. There were no cases of graft thrombosis or delayed graft function. Overall survival was 96.4%, 88.0%, 76.23% and 50.5% at 1, 5, 10 and 20 years respectively. ConclusionEn-bloc paediatric kidney transplantation is associated with excellent long-term allograft and patient survival and is a feasible strategy for increasing the transplant donor pool in carefully selected recipients.

Renal Resistance Trend During Hypothermic Machine Perfusion Is More Predictive of Postoperative Outcome Than Biopsy Score: Preliminary Experience in 35 Consecutive Kidney Transplantations.

Hypothermic machine perfusion (HPM) grants a better postoperative outcome in transplantation of organs procured from extended criteria donors (ECDs) and donors after cardiac death (DCD). So far, the only available parameter for outcome prediction concerning those organs is pretransplant biopsy score. The aim of this study is to evaluate whether renal resistance (RR) trend during HPM may be used as a predictive marker for post-transplantation outcome. From December 2015 to present, HMP has been systematically applied to all organs from ECDs and DCD. All grafts underwent pretransplantation biopsy evaluation using Karpinski's histological score. Only organs that reached RR value ≤1.0 within 3 hours of perfusion were transplanted. Single kidney transplantation (SKT) or double kidney transplantation (DKT) were performed according to biopsy score results. Sixty-five HMPs were performed (58 from ECDs and 7 from DCD/ECMO donors). Fifteen kidneys were insufficiently reconditioned (RR > 1) and were therefore discarded. Forty-nine kidneys were transplanted, divided between 21 SKT and 14 DKT. Overall primary nonfunction (PNF) and delayed graft function (DGF) rate were 2.9 and 17.1%, respectively. DGF were more common in kidneys from DCD (67 vs. 7%; P = 0.004). Biopsy score did not correlate with PNF/DGF rate (P = 0.870) and postoperative creatinine trend (P = 0.796). Recipients of kidneys that reached RR ≤ 1.0 within 1 hour of HMP had a lower PNF/DGF rate (11 vs. 44%; P = 0.033) and faster serum creatinine decrease (POD10 creatinine: 1.79 mg/dL vs. 4.33 mg/dL; P = 0.019). RR trend is more predictive of post-transplantation outcome than biopsy score. Hence, RR trend should be taken into account in the pretransplantation evaluation of the organs.

Factors and outcomes in association with sepsis differ between simultaneous pancreas/kidney and single kidney transplant recipients.

As immunosuppressive therapy has improved in simultaneous pancreas/kidney transplant recipients (SPKTRs), infection has become the major limitation of disease-free survival. We studied all SPKTRs and deceased-donor kidney transplant recipients (KTRs) between 2003 and 2015. Thirty-six of 134 SPKTRs (26.9%) were diagnosed with sepsis among which 13/36 SPKTRs (36.1%) developed severe sepsis/septic shock. A control group of 98 SPKTRs without sepsis and 61/538 KTRs (11.3%) with sepsis were used for comparison. Among SPKTRs, female sex, low BMI, CMV seronegativity, CMV disease, and acute cellular rejection increased the risk for sepsis (P < .05). Patient and allograft survival was comparable among SPKTRs with and without sepsis (P > .05), but showed inferior kidney allograft function (P < .05). While urosepsis was less common among SPKTRs (45%), pneumonia (33%) and peritonitis (15%) as site of infections were more frequent (P < .05). Here, gram-positive and fungal sepsis were more common among SPKTRs compared to KTRs (P < .05). SPKTRs showed a higher incidence and an earlier onset of sepsis compared to KTRs (P < .001). SPKTRs with severe sepsis/septic shock were more likely to show pneumonia as site of infection with gram-positive/polymicrobial bacteremia (P < .05). Mortality from severe sepsis was 29% among SPKTRs compared to 58% among KTRs (P < .05). Differences in incidence, site, causative pathogens, and onset of sepsis between SPKTRs and KTRs may be attributed to more intense immunosuppression, major surgery, and complications of diabetes among SPKTRs. Lower sepsis-related mortality may reflect younger age and more timely diagnosis, but also supports recent findings of less sepsis-related mortality among recipients of solid organ transplantation.

Renal Transplants from Older Deceased Donors: Use of Preimplantation Biopsy and Differential Allocation to Dual or Single Kidney Transplant according to Histological Score Has No Advantages over Allocation to Single Kidney Transplant by Simple Clinical Indication.

Background Grafts from elderly donors (ECD) are increasingly allocated to single (SKT) or dual (DKT) kidney transplantation according to biopsy score. Indications and benefits of either procedure lack universal agreement. Methods A total of 302 ECD-transplants in period from Jan 1, 2000, to Dec 31, 2015, were allocated to SKT (SKTpre) on clinical grounds alone (before Dec 2010, pre-DKT era, n = 170) or according to a clinical-histological protocol (after Dec 2010, DKT era, n = 132) to DKT (n = 48), SKT biopsy-based protocol (“high-risk”, SKThr, n = 51), or SKT clinically based protocol (“low-risk”, SKTlr, n = 33). Graft and patient survival were compared between the two periods and between different transplant categories. Results Graft and overall survival in recipients from ECD in pre-DKT and DKT era did not differ (5-year graft survival 87.7% and 84.2%, resp.); equal survival in the 2 ECD periods was shown in both donor age ranges of 60–69 and >70-years, and in low-risk or high-risk ECD categories. Within the DKT protocol SKThr showed worst graft and overall survival in the 60–69 donor age range; DKT did not result in significantly better outcome than SKT from ECD in either era. One-year posttransplant creatinine clearance in recipients did not differ between any ECD transplant category. At 3 and 5 years after transplantation there were significantly higher total dialysis-free recipient life years from an equal donor number in the pre-DKT era than in the DKT protocol. Conclusions Use of a biopsy-based protocol to allocate grafts from aged donors to SKT or DKT did not result in better short term graft survival than a clinically based protocol with allocation only to SKT and reduced overall recipient dialysis-free life years in time.

The recovery status from delayed graft function can predict long-term outcome after deceased donor kidney transplantation

The effect of delayed graft function (DGF) recovery on long-term graft outcome is unclear. The aim of this study was to examine the association of DGF recovery status with long-term outcome. We analyzed 385 recipients who underwent single kidney transplantation from brain-dead donors between 2004 and 2015. Patients were grouped according to renal function at 1 month post-transplantation: control (without DGF); recovered DGF (glomerular filtration rate [GFR] ≥ 30 mL/min/1.73 m2); and incompletely recovered DGF group (GFR < 30 mL/min/1.73 m2). DGF occurred in 104 of 385 (27%) recipients. Of the DGF patients, 70 recovered from DGF and 34 incompletely recovered from DGF. Death-censored graft survival rates for control, recovered DGF, and incompletely recovered DGF groups were 95.3%, 94.7%, and 80.7%, respectively, at 5 years post-transplantation (P = 0.003). Incompletely recovered DGF was an independent risk factor for death-censored graft loss (HR = 3.410, 95%CI, 1.114-10.437). DGF was associated with increased risk for patient death regardless of DGF recovery status. Mean GFRs at 5 years were 65.5 ± 20.8, 62.2 ± 27.0, and 45.8 ± 15.4 mL/min/1.73 m2 for control, recovered, and incompletely recovered DGF groups, respectively (P < 0.001). Control group and recovered DGF patients had similar renal outcomes. However, DGF was associated with increased risk for patient death regardless of DGF recovery status.

Graft survival of en bloc versus single kidney transplantation from small pediatric donors: a meta-analysis with trial sequential analysis

Background: Although renal transplantation from small pediatric donors can relieve the pressure of the shortage of organs, the graft survival differs among different studies. We conducted this meta-analysis to evaluate the prognosis of patients receiving en bloc versus single allograft from small pediatric donors. Methods: A systematic search in PubMed, Embase, and web of science was performed to identify relevant studies. Individual hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were combined to calculate the prognostic value. A cumulative meta-analysis based on publication year was also conducted. Trial sequential analysis (TSA) was performed to estimate the quantity of the evidence. Results: Seven studies consisting of 4,284 cases were included, and risk estimates from six of these studies were finally pooled for quantitative analysis. We found that compared with single kidney transplantation from small pediatric donors, en bloc kidney transplant suggested a better graft outcome of recipients (HR=0.57, 95% CI: 0.49–0.67). The findings in the current study were based on sufficient evidence by TSA. Furthermore, no evidence of publication bias in the meta-analysis was noted. Conclusions: En bloc kidney transplantation from small pediatric donors was significantly associated with a superior graft survival when compared with single kidney transplant.

Dual en bloc technique for adult renal transplantation.

We describe and provide follow-up for a novel simplified technique permitting dual en bloc (DEB) transplantation of adult organs using single in situ arterial and venous anastomoses. Twenty-two adult DEB transplants were performed at our center between 2001 and 2012, utilizing 44 kidneys en bloc. Results were compared with 20 solitary transplants from expanded criteria donors (ECD) associated with lower terminal serum creatinines and Remuzzi biopsy scores vs DEB group. Adult DEB implants had donor inferior vena cava connected to recipient external iliac vein and "Y" arterial interposition graft anastomosed to the recipient iliac artery. Ureters were conjoined prior to implantation as a single patch into the recipient bladder. Mean operative time was 206±57minutes in DEB vs 180±30minutes in single transplants (P<.05). Delayed graft function rate was 23% vs 25% in both groups. At 12-month follow-up, mean serum creatinine was 152±66μmol/L vs in 154±52μmol/L DEB and single kidney transplant recipients, respectively (P=NS). Three-year overall and graft specific survival were 86% and 84% in the DEB group, respectively (P=NS). Complication rates were similar between groups. This DEB renal transplantation technique is safe and effective in adults. By employing techniques used to conjoin organ vasculature ex vivo, the number of in situ anastomoses is reduced, thereby minimizing operative ischemic time and potential for complications associated with extensive vascular dissection.

Dual Kidney Transplantation: A Review of Past and Prospect for Future.

Kidney transplantation (KT) is one of the treatment options for patients with chronic kidney disease. The number of patients waiting for kidney transplantation is growing day by day. Various strategies have been put in place to expand the donor pool. Extended criteria donors are now accepted more frequently. Increasing number of elderly donors with age > 60 years, history of diabetes or hypertension, and clinical proteinuria are accepted as donor. Dual kidney transplantation (DKT) is also more frequently done and experience with this technique is slowly building up. DKT not only helps to reduce the number of patients on waiting list but also limits unnecessary discard of viable organs. Surgical complications of DKT are comparable to single kidney transplantation (SKT). Patient and graft survivals are also promising. This review article provides a summary of evidence available in the literature.