Gill Jagbir, Cho Yong W, Danovitch Gabriel M, Wilkinson Alan, Lipshutz Gerald, Pham Phuong-Thu, Gill John S, Shah Tariq, Bunnapradist Suphamai
David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
Transplantation. 2008 Jan 15;85(1):62-8. doi: 10.1097/01.tp.0000296855.44445.af.
The organ shortage has resulted in increased use of kidneys from expanded criteria donors (ECD). For ECD kidneys unsuitable for single use, dual kidney transplants (DKT) may be possible. There are limited data comparing outcomes of DKT to single kidney ECD transplants, making it unclear where DKT fits in the current allocation scheme. Our purpose was to compare outcomes of DKT and ECD transplants in the United States.
From 2000 to 2005, a total of 625 DKT, 7686 single kidney ECD, and 6,044 SCD transplants from donors aged>or=50 years were identified from the Organ Procurement and Transplantation Network/United Network for Organ Sharing data. Allograft survival was the primary outcome.
DKT comprised 4% of kidney transplants from donors aged>or=50 years. Compared to the ECD donor group, the DKT donor group was older (mean age 64.6+/-7.7 years vs. 59.9+/-6.2 years) and consisted of more African Americans (13.1% vs. 9.9%), and more diabetic donors (16.3% vs. 10.4%; P<0.001). Mean cold ischemic time was longer in DKT (22.2+/-9.7 hr), but rates of delayed graft function were lower (29.3%) compared to ECD transplants (33.6%, P=0.03). Three-year overall graft survival was 79.8% for DKT and 78.3% for ECD transplants.
DKT were infrequent and had outcomes comparable to ECD transplants, despite the use of organs from higher risk donors. With a more upfront approach to DKT by offering this option to patients at the time of wait-listing as part of an ECD algorithm, we may be able to further optimize outcomes of DKT and minimize discard of potential organs.
器官短缺导致扩大标准供体（ECD）肾脏的使用增加。对于不适合单肾移植的ECD肾脏，可能可行双肾移植（DKT）。比较DKT与单肾ECD移植结局的数据有限，这使得DKT在当前分配方案中的地位尚不清楚。我们的目的是比较美国DKT和ECD移植的结局。
从2000年至2005年，从器官获取与移植网络/器官共享联合网络数据中识别出年龄≥50岁的供体进行的625例DKT、7686例单肾ECD移植和6044例标准供体（SCD）移植。移植肾存活是主要结局。
DKT占年龄≥50岁供体肾脏移植的4%。与ECD供体组相比，DKT供体组年龄更大（平均年龄64.6±7.7岁对59.9±6.2岁），非裔美国人更多（13.1%对9.9%），糖尿病供体更多（16.3%对10.4%；P<0.001）。DKT的平均冷缺血时间更长（22.2±9.7小时），但移植肾功能延迟发生率低于ECD移植（29.3%对33.6%，P=0.03）。DKT的三年总体移植肾存活率为79.8%，ECD移植为78.3%。
DKT并不常见，尽管使用了风险更高供体的器官，但其结局与ECD移植相当。通过在等待名单时将DKT作为ECD方案的一部分提供给患者，采用更直接的DKT方法，我们或许能够进一步优化DKT的结局，并尽量减少潜在器官的丢弃。
