DOUBLE RENAL-ALLOGRAFTS SUCCESSFULLY INCREASE UTILIZATION OF KIDNEYS FROM OLDER DONORS WITHIN A SINGLE ORGAN PROCUREMENT ORGANIZATION

Background. In 1994, a policy of double renal allografting (DUAL) was used at two centers within our local organ procurement organization to increase utilization of kidneys from older donors that would otherwis e be discarded. Both kidneys from an older donor (age >60 years) were selectively transplanted into a single adult recipient. Methods. The r elative impact of a DUAL policy on the utilization of older donor kidn eys is examined for the period of April 1994 to April 1996. Actual uti lization is compared with the hypothetical case in which a DUAL policy is not present. Results. In the actual setting, a total of 75 kidneys from older donors (>60 years) were accepted for transplantation. Thir ty-six kidneys were transplanted as singlets, and 16 additional kidney s were transplanted as DUAL renal allografts. Thus, a 44% increase in transplantable kidneys, and a 22% increase in patients transplanted wi th kidneys from older donors, was realized. In the actual setting, 23 older kidneys were discarded; without the DUAL policy, 39 kidneys woul d have been deemed untransplantable. When compared with the actual (n = 52) and hypothetical number of kidneys transplanted without a policy of DUAL transplantation (n = 36), the DUAL policy significantly incre ased the utilization of older donor kidneys (P = 0.01). The actuarial 1-year graft survival rate of the dual kidneys was 100%, with a mean f ollow-up of 11.1+/-2.9 months. Mean 6-month and 1-year serum creatinin e level were 1.76+/-0.4 and 1.63+/-0.6 mg/dl, respectively. Conclusion s. A DUAL policy significantly increased the number of older donor kid neys transplanted in a single organ procurement organization and reduc ed the rate of discard of older donor kidneys over a 2-year period. Lo ng-term follow-up is necessary to substantiate satisfactory graft func tion in DUAL from older donors.