Outcome of dual kidney transplantation from marginal deceased kidney donor
Tarun Kumar Saha1, M. Somasekher1, S. Subramanium2.
1Nephrology, Apollo Hospital, Hyderabad, India; 2Urology, Apollo Hospital, Hyderabad, India
Background: Organ shortage has resulted in increased use of kidneys from expanded criteria donors (ECD). ECD kidneys and donors of extremes of age are unsuitable for single use; dual kidney transplants (DKT) may be possible. There are limited data of such deceased donor dual kidney transplant outcomes in India. Our purpose was to increase awareness of dual kidney transplant from expanded deceased donor, and it's an approach to expand in the organ donor pool.
Methods: Retrospective analysis of patient’s who that had fulfilled the criteria of expanded criteria donors (ECD) over more than one decade from November 2008, to February, 2018. ECD were defined as donors age of 60 years & above with or without co-morbidities or donors over the age of 50 years with two co-morbidities among blood hypertension, death from cerebrovascular accident, or terminal serum creatinine levels >1.5 mg/dl. DKT was done in whom donor had fulfilled the criteria of ECD with age over 65 or donor age more than 60 with any co-morbidity. All were given ATG induction (3- 5)mg per Kg, and triple immunosuppressant with steroid, tacrolimus and mycofenolate sodium, and fluconaszole (3 months), valgancyclovir (6 months) and co-trimoxazole(12 mpnths) prophylaxis. The incident of Acute Rejection, Chronic Allograft Rejection, drug toxicity, infection, graft function and other parameters were noted.
Results: 10 patients underwent DKT from expanded criteria donors (ECD). Mean donor age was 65.5 years. One recipient expired after 10 months of post transplant due to Haemolytic Uremic Syndrome (HUS). The combined incidence of delayed graft function was 10% (1/10). Mean 12-months average glomerular filtration rate WAS 48 ml/. Average cold ischemic time was 6hr. Average serum creatinine at discharge was 1.2 mg/dl. Average serum creatinine at 3 years (n=7) were 1.45mg/dl. One year overall graft survival was 90%. One patient developed T cell mediated acute cellular rejection after 10 days of transplant which was successfully treated with pulse steroid and one patient developed recurrent Immunoglobuline A (IgA) nephropathy after 10 months of transplant. One patient developed chronic allograft nephropathy after 2 years of the transplant in ECD group.
Conclusions: Dual Kidney Transplantation using kidneys from marginal elderly donors appear to offer a viable option to counteract the shortage of acceptable kidney donors.
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