D'Arcy Frank T, O'Connor Kevin M, Shields William, Zimmerman Jose A, Mohan Ponnusamy, Eng Molly, Little Dilly M, Power Richard, Dorman Anthony, Hickey David P
National Kidney and Pancreas Transplantation Unit, Beaumont Hospital, Dublin, Ireland.
J Urol. 2009 Oct;182(4):1477-81. doi: 10.1016/j.juro.2009.06.021. Epub 2009 Aug 15.
The critical shortage of kidneys available for transplantation has led to alternate strategies to expand the pool. Transplantation of the 2 kidneys into a single recipient using organs suboptimal for single kidney transplantation was suggested. We assessed results in 24 grafts allocated for dual kidney transplantation vs those in a control group of 44 designated for single kidney transplantation. Each group underwent pretransplant biopsy and recipients were age matched.
Dual kidney transplantation was done in 24 of 1,091 transplants (2.1%) from 2001 to 2008. In patients with dual kidney transplant vs single kidney transplant mean recipient age was 60.6 vs 60.8 years, mean HLA-A, B and DR mismatches were 3.3 vs 2.9, and average patient waiting time was 15.6 vs 13.9 months. All grafts were perfused with University of Wisconsin solution with a mean cold ischemia time of 17.9 hours. On donor dual kidney biopsy in the dual kidney transplant vs single kidney transplant group the average fibrosis rate was 30% (range 25% to 45%) vs 25% (range 3% to 40%) and the glomerulosclerosis rate was 17.9% (range 3.2% to 40.7%) vs 7.1% (range 0% to 50%).
Good postoperative renal function was noted in 14 dual kidney transplantation cases. Acute tubular necrosis requiring dialysis developed in 5 patients as well as acute rejection in 1. Two dual kidney recipients (8%) died in the postoperative period with no single kidney deaths. One patient underwent bilateral transplantectomy. Mean anesthesia time was longer in the dual group (371 vs 212 minutes). Patient and graft survival was equivalent to that in the control group at 36 months.
Careful selection of marginal kidneys based on clinical and histological criteria allows the use of organs that would not ordinarily be sufficient for transplantation with acceptable outcomes. This is a valid strategy to address the organ shortage.
可用于移植的肾脏严重短缺促使人们采取替代策略来扩大供肾库。有人建议将两个肾脏移植给一名受者，使用的是对单肾移植而言不太理想的器官。我们评估了分配给双肾移植的24例移植物的结果，并与指定进行单肾移植的44例对照组的结果进行了比较。每组均进行了移植前活检，且受者年龄匹配。
2001年至2008年期间，在1091例移植手术中有24例（2.1%）进行了双肾移植。双肾移植患者与单肾移植患者相比，受者平均年龄分别为60.6岁和60.8岁，HLA - A、B和DR错配平均数分别为3.3和2.9，患者平均等待时间分别为15.6个月和13.9个月。所有移植物均用威斯康星大学溶液灌注，平均冷缺血时间为17.9小时。在双肾移植组与单肾移植组中，供体双肾活检的平均纤维化率分别为30%（范围25%至45%）和25%（范围3%至40%），肾小球硬化率分别为17.9%（范围3.2%至40.7%）和7.1%（范围0%至50%）。
14例双肾移植病例术后肾功能良好。5例患者发生需要透析的急性肾小管坏死，1例发生急性排斥反应。2例双肾移植受者（8%）在术后死亡，单肾移植受者无死亡病例。1例患者接受了双侧移植肾切除术。双肾移植组平均麻醉时间更长（371分钟对212分钟）。36个月时患者和移植物存活率与对照组相当。
根据临床和组织学标准仔细挑选边缘性肾脏，可使通常不足以用于移植的器官得以使用，并获得可接受的结果。这是解决器官短缺问题的一种有效策略。
