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Dual kidney transplantation from uncontrolled deceased donors after cardiac arrest: a possible option
William Hanf1, Palmina Petruzzo, Vannary Meas-Yedid
1Department of Nephrology, Transplantation and Clinical Immunology, Edouard Herriot Hospital, Lyon, France.
Abstract:
Organ shortage is a major problem in organ transplantation. For this reason, transplantation teams have found it necessary to revisit their organ acceptance criteria. Uncontrolled deceased donors after cardiac arrest could increase the donor pool by 20%, but at the same time there is a greater risk of delayed graft function and primary non-function. Dual kidney transplantation is an option when single kidney transplantation cannot be carried out because of lack of organ quality. We report for the first time our four first dual kidney transplantation from uncontrolled deceased donors after cardiac arrest with a follow up longer than 1 year. We described graft outcomes until 5 years, and histology at 3 and 12 months after transplantation. All organs were machine perfused in order to assess their quality leading to a single kidney transplantation or dual kidney transplantation decision. After 1 year of follow up, all grafts were functional with a mean estimated glomerular filtration rate of 44.5 ± 3.3 mL/min/1.73 m(2), and a mean inulin clearance of 43.7 ± 13.6 mL/mn/1.73 m(2). These findings suggest that dual kidney transplantation can represent a viable option for kidneys unsuitable for single kidney transplantation without increasing the rate of surgical complications. Successful transplantation is linked to histological, biological and donor clinical criteria, as well as perfusion parameters.
Insights
Dual kidney transplantation from uncontrolled deceased donors after cardiac arrest offers a viable solution to organ shortage. This approach successfully utilizes lower-quality organs, achieving good graft function beyond one year.
Area of Science:
- Nephrology
- Transplantation Surgery
- Organ Donation
Background:
- Organ shortage remains a critical challenge in transplantation.
- Uncontrolled deceased donors after cardiac arrest (UDDCA) could expand the donor pool by 20%.
- Organs from UDDCA donors may have higher risks of delayed graft function or primary non-function.
Purpose of the Study:
- To evaluate the outcomes of dual kidney transplantation (DKT) using organs from UDDCA.
- To assess graft function and histology in DKT recipients with over one year of follow-up.
- To determine if DKT is a viable option for kidneys unsuitable for single kidney transplantation.
Main Methods:
- Retrospective analysis of four DKT cases from UDDCA.
- Machine perfusion of all donor kidneys to assess quality and guide transplantation decisions.
- Graft outcome assessment up to 5 years post-transplantation.
- Histological analysis at 3 and 12 months post-transplantation.
Main Results:
- All DKT grafts were functional at 1-year follow-up.
- Mean estimated glomerular filtration rate (eGFR) was 44.5 ± 3.3 mL/min/1.73 m² at 1 year.
- Mean inulin clearance was 43.7 ± 13.6 mL/min/1.73 m² at 1 year.
- No increase in surgical complications was observed compared to single kidney transplantation.
Conclusions:
- DKT from UDDCA is a feasible strategy to increase kidney transplantation rates.
- Careful selection based on histological, biological, donor clinical criteria, and perfusion parameters is crucial for success.
- DKT provides a viable alternative for marginal quality kidneys, improving graft utilization without compromising patient safety.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure