WHEN SHOULD EXPANDED CRITERIA DONOR KIDNEYS BE USED FOR SINGLE VERSUS DUAL KIDNEY TRANSPLANTS?1

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Abstract
To increase the utilization of cadaveric donor kidneys, we have recently expanded our acceptable criteria to include aged donors (frequently with a history of hypertension), by selectively using both donor kidneys (dual transplant) into a single recipient. To define when these expanded criteria donor (ECD) kidneys should be used as a single versus a dual kidney transplant, we retrospectively reviewed 52 recipients of ECD kidneys that had been turned down by all other local centers between 1/1/95 and 11/15/96. Fifteen patients received dual transplants, whereas the remaining 37 received single kidneys. Of the dual kidney recipients, 14 of 15 ECD were ≥59 years of age, 10 of 15 were hypertensive, and 9 of 15 were both. Of the single recipients, 11 of 37 ECD were ≥59 years of age, 11 of 37 were hypertensive, and 7 of 37 were both. All patients received cyclosporine-based triple-drug therapy. We compared seven donor (D) and sixteen recipient outcome variables in single versus dual kidney transplants as subgrouped by: (1) donor admission creatinine clearance(D-AdCCr) 24 hr. In the group with D-AdCCr <90, there was a significantly higher incidence of delayed graft function (DGF) in single versus dual recipients (9 of 20 [45%] vs. 1 of 11 [9%]; P =0.04) and worse early graft function based upon mean serum creatinine at 1 and 4 weeks(5.3±3.3 and 2.8±2.0 vs. 1.7±0.6 and 1.4±0.5 mg/dl; P <0.05). In the group with D-age ≥59, recipients of single kidneys had significantly higher mean serum creatinine at 1, 4, and 12 weeks versus recipients of dual kidneys (5.1±3.3, 3.4±2.1, 2.8±1.5 versus 2.8±2.5, 1.5±0.6, 1.6±0.5 mg/dl; P <0.05). Cld Stg time also had an impact on DGF and early outcome. Recipients of dual kidneys stored less than 24 hr had a significantly lower incidence of DGF versus single kidneys stored more than 24 hr (10% vs. 46%; P <0.05) and better early graft function based on mean serum creatinine at 1, 4, and 12 weeks (1.9±0.8, 1.3±0.4, 1.5±0.2 vs. 6.6±3.4, 3.0±1.6, 2.9±1.9 mg/dl; P <0.05). The overall 1-year patient and graft survivals were 96% and 81% vs. 93% and 87%( P =NS) in recipients of single ECD versus dual ECD kidneys. In conclusion, we believe that kidneys from ECD with D-AdCCr<90 ml/min and D-age ≥59 should be used as dual kidney transplants, keeping the Cld Stg time at <24 hr to minimize the effect of Cld Stg on early graft function.