Multicenter study on double kidney transplantation.

BACKGROUND: Marginal organs not suitable for single kidney transplantation are considered for double kidney transplantation (DKT). Herein we have reviewed short and long-term outcomes of DKT over a 7-year experience. PATIENTS AND METHODS: Between 2001 and 2007, 80 DKT were performed in the transplant centers of Bologna, Parma, and Modena, Italy. Recipient mean age was 61 +/- 5 years. The main indications were glomerular nephropathy (n = 33) and hypertensive nephroangiosclerosis (n = 14). Mean HLA A, B, and DR mismatches were 3.1 +/- 1.2. Donor mean age was 69 +/- 8 years and mean creatinine clearance was 75 +/- 27 mL/min. Almost all kidneys were perfused with Celsior solution. Mean cold ischemia time was 17 +/- 4 hours and mean warm ischemia time was 41 +/- 17 minutes. Mean biopsy score was 4.4. Immunosuppression was based on tacrolimus (n = 52) or cyclosporine (n = 26). RESULTS: Fifty (62.5%) patients displayed good postoperative renal function. Thirty (37.5%) experienced acute tubular necrosis and required postoperative dialysis treatment; 8 acute rejections occurred. Urinary complications were 13.7% with 8/11 requiring surgical revision. There were 6 surgical reexplorations: intestinal perforation (n = 2), bleeding (n = 3), and lymphocele (n = 1). Two patients lost both grafts due to vascular and infectious complications at 7 or 58 days after transplantation. Two patients underwent intraoperative transplantectomy due to massive vascular thrombosis. Four (5%) patients underwent transplantectomy of a single graft due to vascular complications (n = 2), bleeding (n = 1), or infectious complications (n = 1). Graft and patient survivals were 95% and 100% versus 93% and 97% at 3 versus 36 months, respectively. CONCLUSIONS: DKT is a safe approach for organ shortage. The score used in this study is useful to determine whether a kidney should be refused or accepted.