Double versus single renal allografts from aged donors

Area of Science:

• Nephrology
• Transplantation Surgery
• Geriatric Medicine

Background:

• Increasing demand for renal transplants necessitates utilizing older donor kidneys.
• Simultaneous double kidney transplantation (SDKT) is explored to maximize organ use.
• Careful donor selection is crucial to avoid negative impacts on transplant numbers.

Purpose of the Study:

• To establish a protocol for extending cadaver donor selection without an age limit.
• To evaluate the efficacy of SDKT using elderly donor kidneys.
• To optimize single kidney transplantation from older donors.

Main Methods:

• Developed a protocol for donor selection based on age and glomerulosclerosis (GE) percentage.
• Performed pregraft renal biopsy for donors ≥60 years.
• Utilized SDKT for donors ≥75 years or with GE >15%; single transplantation for donors 60-74 years with GE <15%.

Main Results:

• 181 patients underwent transplantation; 21 in SDKT group, 40 in single transplant (60-74 yrs), 120 in single transplant (<60 yrs).
• SDKT group showed significantly higher immediate graft function (76%) compared to single transplant groups.
• One-year patient and graft survival rates were excellent across all groups, with no significant differences.

Conclusions:

• SDKT enables the use of kidneys from donors >75 years or with GE >15%.
• Kidneys from donors aged 60-74 with GE <15% can be successfully used for single transplantation in two recipients.
• The protocol effectively expands donor pool and optimizes kidney utilization in transplantation.