Dual kidney transplantation: Older donors for older recipients

Background: Dual kidney transplantation, the transplantation of both donor kidneys into a single recipient, allows increased use of expanded criteria donors (eg, older donors with a history of hypertension) to alleviate the d isparity between available donors and potential recipients. We evaluated ou tcomes in our dual kidney transplant program that started in 1995. Study Design: A retrospective comparison of donor and recipient data betwee n recipients of dual (n = 41) versus single (n = 199) cadaveric renal trans plants from February 1, 1995, to March 22, 1998, was performed. Dual kidney transplantation was selectively performed when the calculated donor admiss ion creatinine clearance was less than 90 mL/min and the donor age was grea ter than 60 years, or if the donor had an elevated terminal serum creatinin e. Every attempt was made to age- and size-match the donor and recipients. Results: Recipients of dual kidneys had donors who were older than single k idney donors (59 +/- 12 versus 42 +/- 17 years respectively, p < 0.0001) an d had more hypertension (51% versus 29%, p = 0.024). Average urine output w as lower in the dual versus single kidney group (252 +/- 157 versus 191 +/- 70 mL/hr, p = 0.036). Donors for dual kidney recipients had a lower donor admission creatinine clearance of 82 +/- 28 mL/min versus 105 +/- 45 mL/min in the single kidney group (p = 0.005). Recipients of dual versus single k idneys were older (58 +/- 11 versus 47 +/- 12 years, p > 0.0001). Dual vers us single kidney recipients had similar serum creatinines up to 2 years pos ttransplant (1.6 +/- 0.3 versus 1.6 +/- 0.7 mg/dL at 2 years, p = NS) and a comparable incidence of delayed graft function (24% versus 33%, p = NS) an d 3-month posttransplant creatinine clearance (54 +/- 23 versus 57 +/- 25 m L/min, p = NS). One-year patient and graft survival for single kidney trans plantation was 97% and 90%, respectively, and 98% and 89% for dual kidney t ransplantation (p = NS). Conclusions: Dual kidney donors were significantly older had more hypertens ion, lower urine outputs, and lower donor admission creatinine clearance. D espite these differences, dual kidney recipients had comparable postoperati ve function, outcomes, and survival versus single kidney recipients. We bel ieve selective use of dual kidney transplantation can provide excellent out comes to recipients of kidneys from older donors with reduced renal functio n. (J Am Cell Surg 1999;189:82-92. (C) 1999 by the American College of Surg eons).