Bertelli R, Nardo B, Capocasale E, Cappelli G, Cavallari G, Mazzoni M P, Benozzi L, Dalla Valle R, Fuga G, Busi N, Gilioli C, Albertazzi A, Stefoni S, Pinna A D, Faenza A
Transplant Center of Bologna, Bologna, Italy.
Transplant Proc. 2008 Jul-Aug;40(6):1869-70. doi: 10.1016/j.transproceed.2008.05.025.
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.
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).
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.
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.
不适合单肾移植的边缘器官可考虑用于双肾移植（DKT）。在此，我们回顾了7年经验中DKT的短期和长期结果。
2001年至2007年期间，意大利博洛尼亚、帕尔马和摩德纳的移植中心进行了80例DKT。受者平均年龄为61±5岁。主要适应证为肾小球肾病（n = 33）和高血压性肾血管硬化（n = 14）。HLA A、B和DR的平均错配数为3.1±1.2。供者平均年龄为69±8岁，平均肌酐清除率为75±27 mL/min。几乎所有肾脏均用赛而液灌注。平均冷缺血时间为17±4小时，平均热缺血时间为41±17分钟。平均活检评分为4.4。免疫抑制基于他克莫司（n = 52）或环孢素（n = 26）。
50例（62.5%）患者术后肾功能良好。30例（37.5%）发生急性肾小管坏死，需要术后透析治疗；发生8次急性排斥反应。泌尿系统并发症发生率为13.7%，其中8/11例需要手术修复。进行了6次手术再探查：肠穿孔（n = 2）、出血（n = 3）和淋巴囊肿（n = 1）。2例患者因移植后7天或58天出现血管和感染并发症而失去了两个移植物。2例患者因大量血管血栓形成而在术中进行了移植肾切除术。4例（5%）患者因血管并发症（n = 2）、出血（n = 1）或感染并发症（n = 1）而进行了单个移植物的移植肾切除术。移植肾和患者的生存率在3个月时分别为95%和100%，在36个月时分别为93%和97%。
DKT是解决器官短缺的一种安全方法。本研究中使用的评分有助于确定一个肾脏是否应被拒绝或接受。
