ABSTRACT
Objective:To explore the safety and feasibility of optimized pathological evaluation system of donor's kidney and modified surgery during adult dual kidney transplantation(DKT)and evaluate its effectiveness to provide more alternative protocols for kidney transplantation from extended criteria donors.Methods:DKT was performed in 10 recipients using the same protocol from June 2019 to May 2021.And retrospective reviewing was performed for clinical data, including characteristics of donors and recipients, optimized pathological evaluation system, modified surgery, treatment regimens, complications and follow-ups.Results:There were 8 male and 2 female donors with an age of(57.9±12.8)years and BMI(24.1±4.1)kg/m 2.The percentage of DCD was 70% and DBD 30%.The serum creatinine before procurement was 107.6(93.3-163.5)μmol/l.Zero-point puncture biopsy was performed for both kidneys and optimized pathological evaluation system was implemented(Banff criteria & Remuzzi score). The pathological results indicated that glomerular sclerosis for left and right kidneys were 2.0(1.5-2.0)and 1.5(1.0-2.0). And Remuzzi score for left and right kidneys were(4.4±1.2)and(3.6±1.5)points respectively.All recipients were male with an age of(43.1±9.0)years and BMI(22.2±1.9)kg/m 2.All PRAs were negative pre-operation.Modified surgery was performed in all recipients(two kidneys were implanted outside iliac vessels without patch and artery of superior kidney was anastomosed to internal iliac artery). Operative duration was(195±54.3)min and serum creatinine before discharge 125.0(102.0-199.0)μmol/L.Renal dynamic scintigraphy indicated that glomerular filtration rate was(30.0±8.2)ml/min for left kidney and(29.2±13.9)ml/min for right kidney.MRA results indicated that morphologies of renal arteries and veins were regular.The time between operation and discharge was(22.4±4.7)days.Compared with SKT, serum creatinine before discharge of DKT was lower and DGF incidence of DKT was higher without statistical significance.The time between operation and discharge was longer for DKT than that for SKT( P<0.05). The complications consisted of 20% donor derived infection(DDI)and 50% DGF.And there was no surgical complication associated with vessels and ureter.Renal function remained stable during 6-month follow-ups. Conclusions:Optimized pathological evaluation system of donor's kidney and modified surgery during adult dual kidney transplantation are both safe and feasible.The postoperative function of transplanted dual kidney is successfully restored.However, long-term follow-ups are required for evaluating its effectiveness.
ABSTRACT
Objective:To explore the outcome of kidney transplantation from donation after cadaveric death(DCD)with high pathological Remuzzi score.Methods:From January, 2019 to December, 2019, 31 recipients of kidney allograft transplantation from marginal donors with Remuzzi score≥4 in preimplantation biopsy were retrospectively enrolled. They were divided into two groups of dual kidney transplantation(DKT, 14 cases)and single kidney transplantation(SKT, 17 cases). Median Remuzzi score of left kidney(5.05 in DKT group vs 4.92 in SKT group)or right kidney(5.26 vs. 4.58)was comparable. Dual donor kidneys were implanted into ipsilateral iliac fossa. Survival outcomes, kidney function, acute rejection episodes, incidence of delayed graft function(DGF)and proteinuria were recorded within Year 1 post-operation.Results:Proportion of male(92.9% vs. 52.9%, P<0.05)and recipient's body mass index(BMI, 23.93 vs. 21.09)were significant higher in DKT group than those in SKT group. One graft failure occurred in DKT group at Month 11 post-operation. The 1-year graft survival rate was 92.9% in DKT group and 1-year recipient survival rate both 100% in two groups. Mean 12-month serum creatinine[SCr, (164±37.7)μmol/L vs. (154.92±96.2)μmol/L]and estimated glomerular filtration rate[eGFR, (41.84±9.01) vs. (44.8±18.16)ml/(min·1.73m 2)]were comparable between two groups(both P>0.05). There was no occurrence of thrombosis resulting in graft loss. One-year incidence of acute rejection, rate of DGF(42.9% vs 41.2%)and proteinuria(57.1% vs. 41.2%)were comparable between two groups(both P>0.05). Conclusions:Through donor-recipient matching and dual kidney transplant allocation, short-term survival outcome of kidney allograft from marginal donors with high Remuzzi score≥4 is encouraging. However, long-term outcomes should be further examined.