Adult Dual Kidney Transplantation Following Dual Renal Endarterectomy: A Case Series

Dual kidney transplantation (DKT) represents a method of expanding the donor pool and minimizing kidney nonutilization. For kidneys with severe renal artery atherosclerosis, back-bench eversion endarterectomy (EE) may be performed as a salvage procedure to further promote utilization.

We report five cases of DKT in which both kidneys underwent EE prior to implantation.

Mean donor age was 60.2 ± 5.5 years, mean KDPI 84 ± 15%, and mean terminal serum creatinine 0.88 ± 0.3 mg/dL. There were three expanded criteria and three donations after circulatory death donors. All but one kidney was managed with hypothermic machine preservation (five with suboptimal pump parameters) and two were imported. Percentage glomerulosclerosis on biopsy ranged from 7% to 30% and cold ischemia times from 19.2 to 33.5 h. Mean recipient age was 63.0 ± 6.5 years, mean EPTS 65 ± 30%, and mean dialysis duration 19 ± 10.3 months. All recipients were chosen based on out-of-sequence allocation (median match run sequence #1480). Operating times ranged from 4 to 7 h; three cases were performed as unilateral and two bilateral extraperitoneal transplants. Three patients experienced delayed graft function; initial length of hospital stay ranged from 3 to 7 days. At 6 months follow-up, mean serum creatinine was 1.6 ± 0.3 mg/dL and GFR 46 ± 17 mL/min/1.73m². One patient died at 43 months, but the remaining four patients are doing well at a mean follow-up of 29 months. There were no vascular complications.

Based on this preliminary experience, we believe that acceptable outcomes can be achieved with DKT in appropriately selected cases, even in the setting of severe donor renal artery atherosclerosis requiring dual endarterectomy.