39th National Congress of the Italian Society of Organ Transplantation
Renal transplantation
Expanded Criteria Donor Kidney Transplantation: Comparative Outcome Evaluation Between Single Versus Double Kidney Transplantation at 8 Years: A Single Center Experience

https://doi.org/10.1016/j.transproceed.2016.02.007Get rights and content

Abstract

Transplantation of kidneys retrieved from expanded criteria donors is one of the options to expand the pool of available grafts, shorten the waiting time and increase the number of kidney transplant recipients. This study was a retrospective assessment of 99 patients who underwent renal transplantation during the period 2007–2015 with kidneys harvested from expanded criteria donors (ECD) as defined by the United Network for Organ Sharing (UNOS) following routine biopsy of all kidneys obtained by Karpinsky Score. They formed two groups: SKT (67 recipients that received a single kidney) and DKT (32 patients that received dual kidney transplant). An analysis of differences of two groups between graft and patient survival and graft function were performed after 8 years of observation. We observed between two groups the following statistical differences: Donor age (P < .001), basal high risk of recipients (P < .05), wait time before transplant (P < .05), recipient age (P < .001) delayed graft function (P < .005) while we observe similar values of donor renal function, outcome in graft and patient survival and graft function in recipients. The transplantation of kidneys obtained from expanded criteria donor, allows increase in the number of kidney transplants and in the respect of values of biopsy score and the donor renal function, showed in single or dual kidney transplantation with similar graft and patient survival.

Section snippets

Patients and Methods

From May 2007 to April 2015, 99 (36.5%) kidney transplantation as determined according UNOS criteria, including 67 single (SKT) and 32 dual kidneys transplantation (DKT) among an overall experience of 271 cadaveric transplants were performed in the POIT (Polo Ospedaliero Interaziendale Trapianti) Transplant Center in Rome, Italy. The remaining 172 cases were standard criteria transplants. Perfusion in situ used Celsior solution. The candidates on the waiting list are characterized according to

Results

The characteristics of the donors in the two groups were similar in terms of gender, body mass index, cold ischemia time, serum creatinine levels, estimated glomerular filtration rate according to MDRD formula. We observed statistically significant differences between the two groups in the following characteristics: donor age (P < .001), histological score (P < .001), estimated glomerular filtration rate according to Cockroft-Gault formula (P < .04). The characteristics of recipients (SKT vs

Discussion

By expanding the pool of criteria donors, the number of kidney transplantations can increase. We chose to utilize a single kidney from ECD with a good renal function and Karpinsky score of ≤4, we used a score of ≥5 to determine DKT, in a middle and long-term observation confirmed by good results in the literature [8], [9]. In our study, some points merit comments. In donor characteristics, we found statistically significant differences between the two groups in donor age and Karpinsky score,

Conclusion

Several strategies have been implemented to satisfy the demand for more kidney transplantations. One such strategy involves the use of expanded criteria donor kidneys allocated for single or dual grafts place in one recipient. Our decision to allocate grafts based on Karpinsky score (≤4 for SKT and ≥5 for DKT), but above all on creatinine levels at the time of procurement, confirmed a good results of literature data. Our local experience showed similar graft and patient survival in the middle

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