Journal Article

Comparison of first and second kidney transplants from the same deceased donor

Markus Giessing, Tom Florian Fuller, Frank Friedersdorff, Serdar Deger, Danilo Schmidt, Hans-Helmut Neumayer, Klemens Budde and Lutz Liefeldt

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 25, issue 12, pages 4055-4061
Published in print December 2010 | ISSN: 0931-0509
Published online June 2010 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfq338
Comparison of first and second kidney transplants from the same deceased donor

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Background. Cold ischaemic time (CIT) may negatively influence graft function, increase the risk of acute rejection, and have adverse effects on graft and patient survival. This holds true especially for expanded criteria donors. As multi-centre studies on the impact of CIT are potentially biased, we performed a retrospective single-centre analysis of both kidneys from the same deceased donor transplanted consecutively into two recipients.

Methods. A retrospective analysis of 80 kidneys from 40 donors transplanted into 80 recipients between January 1989 and December 2007 was conducted. Transplantations were performed successively due to logistic reasons resulting in a longer CIT for the second transplantation. We compared the outcome of the first (Rank 1) vs. the second (Rank 2) transplantation of the same donor. Ten donors/20 kidneys were allocated in the Eurotransplant Senior Program (ESP).

Results. Overall, no significant difference was found for the number of rejections, delayed graft function (DGF), functional data (creatinine, creatinine clearance and GFR) or graft survival despite a significant difference in CIT of Rank 1 recipients (8.3 h) vs. Rank 2 recipients (14.3 h). Subgroup analysis of kidneys transplanted in the Eurotransplant Senior Program (CIT Rank 1: 7 h vs. Rank 2: 12 h) also showed no difference for all the items studied. Donor kidneys ≥65 years transplanted at Rank 2 had a higher rate of DGF when compared with kidneys from donors <65 years transplanted at Rank 1, and function was better for the young Rank 1 recipients for all the time points measured. Graft- and patient survival did not differ.

Conclusions. We found no difference between the successively transplanted kidneys of the same donor, not even for the expanded criteria donor organs. Nevertheless, assuming a ‘safe’ CIT is not justified, and CIT should always be kept as short as possible.

Keywords: cold ischaemic time; expanded donor criteria; ischaemic time; paired kidney; renal transplantation

Journal Article.  3966 words.  Illustrated.

Subjects: Nephrology

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