Long‐Term Results of Biopsy‐Guided Selection and Allocation of Kidneys From Older Donors in Older Recipients

In our old‐for‐old program, we discard or allocate older extended criteria donor kidneys to single (SKT) or dual kidney transplantation (DKT) depending on histological Remuzzi's score in recipients older than 60 years. Here, we analyze the long‐term results of this program and try to identify i...

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Bibliographic Details
Published in:American journal of transplantation 2012-10, Vol.12 (10), p.2781-2788
Main Authors: Fernández‐Lorente, L., Riera, L., Bestard, O., Carrera, M., Gomà, M., Porta, N., Torras, J., Melilli, E., Gil‐Vernet, S., Grinyó, J. M., Cruzado, J. M.
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Biopsy
Extended criteria donors
Female
graft histology
Health Care Rationing
Humans
Kidney Transplantation
Kidneys
Male
Medical sciences
Middle Aged
renal transplantation
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
survival
Tissue Donors
Transplants & implants
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Summary:In our old‐for‐old program, we discard or allocate older extended criteria donor kidneys to single (SKT) or dual kidney transplantation (DKT) depending on histological Remuzzi's score in recipients older than 60 years. Here, we analyze the long‐term results of this program and try to identify independent predictors of patient and graft survival. Between December 1996 and January 2008, we performed 115 SKT and 88 DKT. Discard rate was 15%. Acute rejection incidence was higher in SKT than in DKT (22.6% vs. 11.4%, p = 0.04). Renal function was better in DKT than in SKT up to 5 years after transplantation. Surgical complications were frequent in DKT. Ten‐year cumulative graft survival was significantly lower in the SKT group (31% vs. 53%, p = 0.03). In SKT, histological score 4 provided similar graft survival than 3 or less, whereas in DKT score 4, 5 or 6 displayed similar outcome. Finally, independent predictors of graft survival were history of major adverse cardiac event and 1‐year serum creatinine, rather than SKT or DKT. In conclusion, this biopsy‐guided old‐for‐old strategy resulted in acceptable long‐term graft survival. Our results suggest that DKT should be considered for scores of 5 or 6 only. This study analyzes a biopsy‐guided strategy for renal allograft allocation and suggests a selective allocation scheme for dual kidney transplantation.
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2012.04153.x