Lee C M, Carter J T, Weinstein R J, Pease H M, Scandling J D, Pavalakis M, Dafoe D C, Alfrey E J
Department of Surgery, University of California-San Francisco, USA.
J Am Coll Surg. 1999 Jul;189(1):82-91; discussion 91-2. doi: 10.1016/s1072-7515(99)00073-3.
Dual kidney transplantation, the transplantation of both donor kidneys into a single recipient, allows increased use of expanded criteria donors (eg, older donors with a history of hypertension) to alleviate the disparity between available donors and potential recipients. We evaluated outcomes in our dual kidney transplant program that started in 1995.
A retrospective comparison of donor and recipient data between recipients of dual (n = 41) versus single (n = 199) cadaveric renal transplants from February 1, 1995, to March 22, 1998, was performed. Dual kidney transplantation was selectively performed when the calculated donor admission creatinine clearance was less than 90 mL/min and the donor age was greater than 60 years, or if the donor had an elevated terminal serum creatinine. Every attempt was made to age- and size-match the donor and recipients.
Recipients of dual kidneys had donors who were older than single kidney donors (59 +/- 12 versus 42 +/- 17 years respectively, p < 0.0001) and had more hypertension (51% versus 29%, p = 0.024). Average urine output was lower in the dual versus single kidney group (252 +/- 157 versus 191 +/- 70 mL/hr, p = 0.036). Donors for dual kidney recipients had a lower donor admission creatinine clearance of 82 +/- 28 mL/min versus 105 +/- 45 mL/min in the single kidney group (p = 0.005). Recipients of dual versus single kidneys were older (58 +/- 11 versus 47 +/- 12 years, p > 0.0001). Dual versus single kidney recipients had similar serum creatinines up to 2 years posttransplant (1.6 +/- 0.3 versus 1.6 +/- 0.7 mg/dL at 2 years, p = NS) and a comparable incidence of delayed graft function (24% versus 33%, p = NS) and 3-month posttransplant creatinine clearance (54 +/- 23 versus 57 +/- 25 mL/min, p = NS). One-year patient and graft survival for single kidney transplantation was 97% and 90%, respectively, and 98% and 89% for dual kidney transplantation (p = NS).
Dual kidney donors were significantly older, had more hypertension, lower urine outputs, and lower donor admission creatinine clearance. Despite these differences, dual kidney recipients had comparable postoperative function, outcomes, and survival versus single kidney recipients. We believe selective use of dual kidney transplantation can provide excellent outcomes to recipients of kidneys from older donors with reduced renal function.
双肾移植，即将两个供肾移植给同一个受者，可增加对扩大标准供者（如患有高血压病史的老年供者）的利用，以缓解可用供者与潜在受者之间的差距。我们评估了始于1995年的双肾移植项目的结果。
对1995年2月1日至1998年3月22日期间接受双肾移植（n = 41）与单肾移植（n = 199）的尸体肾移植受者的供者和受者数据进行回顾性比较。当计算得出的供者入院时肌酐清除率低于90 mL/分钟且供者年龄大于60岁，或供者终末期血清肌酐升高时，选择性地进行双肾移植。尽一切努力使供者与受者在年龄和体型上匹配。
双肾移植受者的供者比单肾移植供者年龄更大（分别为59±12岁和42±17岁，p < 0.0001），且高血压更多（51%对29%，p = 0.024）。双肾组的平均尿量低于单肾组（252±157对191±70 mL/小时，p = 0.036）。双肾移植受者的供者入院时肌酐清除率较低，为82±28 mL/分钟，而单肾组为105±45 mL/分钟（p = 0.005）。双肾移植受者比单肾移植受者年龄更大（58±11岁对47±12岁，p > 0.0001）。双肾移植受者与单肾移植受者在移植后2年内血清肌酐相似（2年时分别为1.6±0.3对1.6±0.7 mg/dL，p = 无显著性差异），移植肾功能延迟发生率相当（24%对33%，p = 无显著性差异），移植后3个月肌酐清除率也相当（54±23对57±25 mL/分钟，p = 无显著性差异）。单肾移植1年的患者和移植物存活率分别为97%和90%，双肾移植为98%和89%（p = 无显著性差异）。
双肾移植供者年龄显著更大，高血压更多，尿量更低，供者入院时肌酐清除率更低。尽管存在这些差异，但双肾移植受者与单肾移植受者的术后功能、结局和存活率相当。我们认为，选择性地使用双肾移植可为肾功能减退的老年供肾受者提供良好的结局。
