Cadaveric "two-in-one" kidney transplantation from marginal donors: Experience of 26 cases after 3 years

Background. Because of the problem of organ shortage, the use of renal transplants from marginal donors has been tested by different procedures. Methods. In our center 26 recipients (59+/-7 years) underwent double renal transplantation from July 1996 to August 1999 using marginal donors (71+/-6 years). A special scoring was applied that included donor age, serum creatinine, the grade of glomerulosclerosis, and kidney weights leading to the decision whether single or dual or no kidney transplantation was performed. Results. After an average follow-up of 18+/-10 months 22 of 26 (85%) double kidney transplant recipients are alive and have functioning grafts. Three patients died with well-functioning grafts. The actuarial 1-year patient and graft survival rate was 94% (n=18), the 8-year rate 92% (n=12). Two patients lost one graft each without becoming dialysis dependent. The average serum creatinine was 1.6+/-0.5 mg/dl after 12 months (n=17) and 1.9+/-0.6 mg/dl after 24 months (n=11). Primary nonfunction occurred in 31%, acute rejection within the first 6 months in 14%. Ten patients who received single old grafts according to our score had similar transplant survival rates but worse graft function after 1 year. Conclusions. Transplant function and survival of patients after dual kidney transplantation indicate that this procedure is reasonable to ameliorate the problem of organ shortage. The most crucial point is to establish a widely accepted standardized scoring for the donors leading to single, dual, or refusal of transplantation.