WHEN SHOULD EXPANDED CRITERIA DONOR KIDNEYS BE USED FOR SINGLE VERSUSDUAL KIDNEY-TRANSPLANTS

Background To increase the utilization of cadaveric donor kidneys, we have recently expanded our acceptable criteria to include aged donors (frequently with a history of hypertension), by selectively using both donor kidneys (dual transplant) into a single recipient. Methods. To define when these expanded criteria donor (ECD) kidneys should be used as a single versus a dual kidney transplant, we retrospectively revie wed 52 recipients of ECD kidneys that had been turned down by all othe r local centers between 1/1/95 and 11/15/96. Fifteen patients received dual transplants, whereas the remaining 37 received single kidneys. O f the dual kidney recipients, 14 of 15 ECD were greater than or equal to 59 years of age, 10 of 15 were hypertensive, and 9 of 15 were both. Of the single recipients, 11 of 37 ECD were greater than or equal to 59 years of age, 11 of 37 were hypertensive, and 7 of 37 were both. Al l patients received cyclosporine-based triple-drug therapy. We compare d seven donor (D) and sixteen recipient outcome variables in single ve rsus dual kidney transplants as subgrouped by: (1) donor admission cre atinine clearance (D-AdZ(Cr)) <90 ml/min; (2) D-age greater than or eq ual to 59 years; and (3) cold storage (Cld Stg) < or >24 hr, Results. In the group with D-AdC(Cr) <90, there was a significantly higher inci dence of delayed graft function (DGF) in single versus dual recipients (9 of 20 [45%] vs. 1 of 11 [9%]; P=0.04) and worse early graft functi on based upon mean serum creatinine at 1 and 4 weeks (5.3+/-3.3 and 2. 8+/-2.0 vs. 1.7+/-0.6 and 1.4+/-0.5 mg/dl; P<0.05). In the group with D-age greater than or equal to 59, recipients of single kidneys had si gnificantly higher mean serum creatinine at 1, 4, and 12 weeks versus recipients of dual kidneys (5.1+/-3.3, 3.4+/-2.1, 2.8+/-1.5 versus 2.8 +/-2.5, 1.5+/-0.6, 1.6+/-0.5 mg/dl; P<0.05). Cld Stg time also had an impact on DGF and early outcome. Recipients of dual kidneys stored les s than 24 hr had a significantly lower incidence of DGF versus single kidneys stored more than 24 hr (10% vs. 46%; P<0.05) and better early graft function based on mean serum creatinine at 1, 4, and 12 weeks (1 .9+/-0.8, 1.3+/-0.4, 1.5+/-0.2 vs. 6.6+/-3.4, 3.0+/-1.6, 2.9+/-1.9 mg/ dl; P<0.05). The overall 1-year patient and graft survivals were 96% a nd 81% vs. 93% and 87% (P=NS) in recipients of single ECD versus dual ECD kidneys. Conclusions. In conclusion, we believe that kidneys from ECD with D-AdC(Cr) <90 ml/min and D-age greater than or equal to 59 sh ould be used as dual kidney transplants, keeping the Cld Stg time at < 24 hr to minimize the effect of Cld Stg on early graft function.