Hospital Universitario Carlos Haya, Málaga, Spain.
Nefrologia. 2012 May 14;32(3):306-12. doi: 10.3265/Nefrologia.pre2011.Dec.11173. Epub 2012 Apr 17.
In order to take full advantage of ECD kidneys, which may not provide sufficient renal mass if used individually, it has been suggested that such organs be used in dual or bilateral kidney transplantation (DTx).
We analysed the experience in a single hospital between May 2007 and March 2011 in a case-control study. Criteria for determining whether to perform single or dual Tx were defined in a protocol in which the biopsy score was important, but not the only factor. Donor's age, medical history, kidney size and creatinine clearance were also considered. During this time period, 80 kidneys from donors over age 65 were transplanted. Single transplants (STx) accounted for 40 of the organs, and another 40 were used in DTx.
Mean donor age for STx was 68.7 ± 3.0 years; for DTx, it was 74.2 ± 4.3 years (P<.001), with more female donors for DTx (75%) than for STx (40%) (P<.001). There were no differences between groups with regard to glomerular filtration rate or proteinuria. Kidneys assigned to DTx received higher biopsy scores than those assigned to STx (2.95 ± 1.01 vs 1.8 ± 1.04; P<.001). DTx recipients were older than STx recipients. There were no differences between the groups regarding cold ischaemia time, delayed graft function, haemorrhagic complications or re-surgeries. However, DTx recipients achieved better creatinine clearance at 1, 3, 6 and 12 months, although the difference was only statistically significant at 6 months (53.4 ± 19.5ml/min vs 44.5 ± 15.6ml/min; P<.05). Renal artery thrombosis appeared in 2 STx patients and in both kidneys of 1 DTx patient. Another 2 patients in the DTx group each lost 1 kidney due to thrombosis and ureteral necrosis respectively, but were able to remain dialysis-free. Graft survival at 3 years was 90% for both groups. During the study period 3 patients died (2 in the STx group and 1 in the DTx group).
Our preliminary experience indicates that DTx provides good results in terms of survival and renal function data, despite surgery being more complicated and the organs having characteristics that probably make them unsuitable for STx. The decision to perform DTx makes using ECD kidneys easier, and it should be based on a combination of pre-transplant histological criteria and the donor's clinical characteristics.
为了充分利用 ECD 肾脏，如果单独使用，可能无法提供足够的肾脏质量，因此有人建议在双肾或双侧肾移植（DTx）中使用这些器官。
我们在一项病例对照研究中分析了 2007 年 5 月至 2011 年 3 月期间在一家医院的经验。在一项方案中确定了决定进行单肾或双肾移植的标准，该方案中活检评分很重要，但不是唯一因素。还考虑了供体的年龄、病史、肾脏大小和肌酐清除率。在此期间，对 80 名年龄超过 65 岁的供体进行了肾脏移植。40 个器官进行了单肾移植（STx），另外 40 个器官用于 DTx。
单肾移植组的供体平均年龄为 68.7 ± 3.0 岁；双肾移植组为 74.2 ± 4.3 岁（P<.001），双肾移植组的女性供体比例（75%）高于单肾移植组（40%）（P<.001）。两组在肾小球滤过率或蛋白尿方面无差异。分配给 DTx 的肾脏接受的活检评分高于分配给 STx 的肾脏（2.95 ± 1.01 对 1.8 ± 1.04；P<.001）。DTx 受者比 STx 受者年龄更大。两组之间在冷缺血时间、延迟移植物功能、出血并发症或再次手术方面无差异。然而，在 1、3、6 和 12 个月时，DTx 受者的肌酐清除率更好，尽管仅在 6 个月时具有统计学意义（53.4 ± 19.5ml/min 对 44.5 ± 15.6ml/min；P<.05）。2 例 STx 患者和 1 例 DTx 患者的双肾均出现肾动脉血栓形成。DTx 组的另外 2 名患者各因血栓形成和输尿管坏死而失去 1 个肾脏，但仍无需透析。两组的 3 年移植存活率均为 90%。在研究期间，有 3 名患者死亡（2 例在 STx 组，1 例在 DTx 组）。
我们的初步经验表明，尽管手术更复杂，且这些器官的特性可能使它们不适合单肾移植，但 DTx 在存活率和肾功能数据方面提供了良好的结果。进行 DTx 的决定使 ECD 肾脏的使用更加容易，并且应该基于移植前的组织学标准和供体的临床特征的组合。
