Samenvatting
DUAL KIDNEY TRANSPLANTATION WITH ORGANS FROM A 77-YEAR OLD DCD III DONOR
L. Pipeleers, T. Bogaerts, I. Luyten, T. Robberechts, M. Vanhoeij, F. Van Hulle, M. Wissing, D. Jacobs-Tulleneers-Thevissen (VUBrussel, Brussel, Belgium)
Several strategies have been developed to expand the donor pool, including the use of organs from donors after controlled circulatory death (DCD III) and older donors with comorbidities. Use of elderly DCD donor kidneys (≥65 years) has been associated with high graft loss and low graft function and use of these organs has been very low in Belgium. Combining two kidneys from these high-risk donors in one recipient could result in a sufficient nephron mass for adequate graft function.
We report the case of an 80-year old male hemodialysis patient with end stage renal disease due to postinfectious glomerulonephritis who was transplanted with both kidneys of a 77-year old female DCD III donor that were refused in extended allocation for single kidney transplantation (SKT). Preimplantation biopsy was not performed. Immunosuppressive treatment consisted of basiliximab, tacrolimus, steroids and mycophenolic acid. First warm ischemia time (WIT) during procurement was 10minutes(min) and cold ischemia times and operative WIT were respectively 6hours(h)26min and 30min for the right kidney implanted into the left iliac fossa and 8h43min and 31min for the left kidney implanted into the right iliac fossa. A surgical re-intervention was performed on post-transplant day 4 for small bowel incarceration in a small peritoneal tear. Graft function recovered immediately after transplantation and the patient was discharged on the 20th postoperative day with a serum creatinine of 1.56 mg/dL and eGFR (CKD-EPI) of 41mL/min/1.73m2. DMSA scan confirmed equal contribution of both transplanted kidneys to the graft function.
This case confirms the feasibility of dual kidney transplantation (DKT) which can contribute to reduce the discard rate of donor kidneys considered unsuitable for SKT. Transplant centers should consider this option for kidneys offered in rescue allocation, preferentially for selected patients on the waiting list who consented in advance as potential candidates for DKT.
L. Pipeleers, T. Bogaerts, I. Luyten, T. Robberechts, M. Vanhoeij, F. Van Hulle, M. Wissing, D. Jacobs-Tulleneers-Thevissen (VUBrussel, Brussel, Belgium)
Several strategies have been developed to expand the donor pool, including the use of organs from donors after controlled circulatory death (DCD III) and older donors with comorbidities. Use of elderly DCD donor kidneys (≥65 years) has been associated with high graft loss and low graft function and use of these organs has been very low in Belgium. Combining two kidneys from these high-risk donors in one recipient could result in a sufficient nephron mass for adequate graft function.
We report the case of an 80-year old male hemodialysis patient with end stage renal disease due to postinfectious glomerulonephritis who was transplanted with both kidneys of a 77-year old female DCD III donor that were refused in extended allocation for single kidney transplantation (SKT). Preimplantation biopsy was not performed. Immunosuppressive treatment consisted of basiliximab, tacrolimus, steroids and mycophenolic acid. First warm ischemia time (WIT) during procurement was 10minutes(min) and cold ischemia times and operative WIT were respectively 6hours(h)26min and 30min for the right kidney implanted into the left iliac fossa and 8h43min and 31min for the left kidney implanted into the right iliac fossa. A surgical re-intervention was performed on post-transplant day 4 for small bowel incarceration in a small peritoneal tear. Graft function recovered immediately after transplantation and the patient was discharged on the 20th postoperative day with a serum creatinine of 1.56 mg/dL and eGFR (CKD-EPI) of 41mL/min/1.73m2. DMSA scan confirmed equal contribution of both transplanted kidneys to the graft function.
This case confirms the feasibility of dual kidney transplantation (DKT) which can contribute to reduce the discard rate of donor kidneys considered unsuitable for SKT. Transplant centers should consider this option for kidneys offered in rescue allocation, preferentially for selected patients on the waiting list who consented in advance as potential candidates for DKT.
| Originele taal-2 | English |
|---|---|
| Status | Published - 16 sep 2022 |
| Evenement | Joint congress Belgian Transplantation Society & Belgian Society of Intensive Care Medecine: Donor Detection and Donor Management - Royal Library of Belgium, Kunstberg , Brussels, Belgium Duur: 16 sep 2022 → 16 sep 2022 |
Conference
| Conference | Joint congress Belgian Transplantation Society & Belgian Society of Intensive Care Medecine |
|---|---|
| Land/Regio | Belgium |
| Stad | Brussels |
| Periode | 16/09/22 → 16/09/22 |