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Original ArticlesTransplantation
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Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom

Maria Ibrahim, George H.B. Greenhall, Dominic M. Summers, Lisa Mumford, Rachel Johnson, Richard J. Baker, John Forsythe, Gavin J. Pettigrew, Niaz Ahmad and Chris J. Callaghan
CJASN September 2020, 15 (9) 1320-1329; DOI: https://doi.org/10.2215/CJN.02060220
Maria Ibrahim
1Department of Nephrology and Transplantation, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
2National Health Service Blood and Transplant, Bristol, United Kingdom
3Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
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George H.B. Greenhall
1Department of Nephrology and Transplantation, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
2National Health Service Blood and Transplant, Bristol, United Kingdom
3Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
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Dominic M. Summers
4Department of Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
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Lisa Mumford
2National Health Service Blood and Transplant, Bristol, United Kingdom
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Rachel Johnson
2National Health Service Blood and Transplant, Bristol, United Kingdom
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Richard J. Baker
5Department of Nephrology, St James’s University Hospital, The Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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John Forsythe
2National Health Service Blood and Transplant, Bristol, United Kingdom
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Gavin J. Pettigrew
4Department of Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
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Niaz Ahmad
6Department of Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
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Chris J. Callaghan
1Department of Nephrology and Transplantation, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
2National Health Service Blood and Transplant, Bristol, United Kingdom
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Abstract

Background and objectives Kidneys from elderly deceased donors are often discarded after procurement if the expected outcomes from single kidney transplantation are considered unacceptable. An alternative is to consider them for dual kidney transplantation. We aimed to examine the utilization of kidneys from donors aged ≥60 years in the United Kingdom and compare clinical outcomes of dual versus single kidney transplant recipients.

Design, setting, participants, & measurements Data from the United Kingdom Transplant Registry from 2005 to 2017 were analyzed. We examined utilization rates of kidneys retrieved from deceased donors aged ≥60 years, and 5-year patient and death-censored graft survival of recipients of dual and single kidney transplants. Secondary outcomes included eGFR. Multivariable analyses and propensity score analysis were used to correct for differences between the groups.

Results During the study period, 7841 kidneys were procured from deceased donors aged ≥60 years, of which 1338 (17%) were discarded; 356 dual and 5032 single kidneys were transplanted. Donors of dual transplants were older (median, 73 versus 66 years; P<0.001) and had higher United States Kidney Donor Risk Indices (2.48 versus 1.98; P<0.001). Recipients of dual transplants were also older (64 versus 61 years; P<0.001) and had less favorable human leukocyte antigen matching (P<0.001). After adjusting for confounders, dual and single transplants had similar 5-year graft survival (hazard ratio, 0.81; 95% CI, 0.59 to 1.12). No difference in patient survival was demonstrated. Similar findings were observed in a matched cohort with a propensity score analysis method. Median 12-month eGFR was significantly higher in the dual kidney transplant group (40 versus 36 ml/min per 1.73 m2; P<0.001).

Conclusions Recipients of kidneys from donors aged ≥60 years have similar 5-year graft survival and better graft function at 12 months with dual compared with single deceased donor kidney transplants.

  • transplant outcomes
  • transplantation
  • survival
  • renal transplantation
  • organ transplant
  • kidney transplantation
  • kidney donation
  • kidney donor
  • utilization
  • deceased donor
  • Received February 17, 2020.
  • Accepted June 17, 2020.
  • Copyright © 2020 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 15 (9)
Clinical Journal of the American Society of Nephrology
Vol. 15, Issue 9
September 07, 2020
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Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom
Maria Ibrahim, George H.B. Greenhall, Dominic M. Summers, Lisa Mumford, Rachel Johnson, Richard J. Baker, John Forsythe, Gavin J. Pettigrew, Niaz Ahmad, Chris J. Callaghan
CJASN Sep 2020, 15 (9) 1320-1329; DOI: 10.2215/CJN.02060220

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Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom
Maria Ibrahim, George H.B. Greenhall, Dominic M. Summers, Lisa Mumford, Rachel Johnson, Richard J. Baker, John Forsythe, Gavin J. Pettigrew, Niaz Ahmad, Chris J. Callaghan
CJASN Sep 2020, 15 (9) 1320-1329; DOI: 10.2215/CJN.02060220
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Keywords

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