Successful Transplantation of Kidneys From Elderly Circulatory Death Donors by Using Microscopic and Macroscopic Characteristics to Guide Single or Dual Implantation

• Published in: American journal of transplantation Vol. 15; no. 11; pp. 2931 - 2939
• Main Authors: Mallon, D. H., Riddiough, G. E., Summers, D. M., Butler, A. J., Callaghan, C. J., Bradbury, L. L., Bardsley, V., Broecker, V., Saeb‐Parsy, K., Torpey, N., Bradley, J. A., Pettigrew, G. J.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.11.2015
• Subjects: Age Factors; Aged; Biopsy; Biopsy, Needle; Cardiovascular Diseases - mortality; Cohort Studies; Delayed Graft Function - epidemiology; Delayed Graft Function - pathology; Donors and donation: donation after circulatory death (DCD); Female; Graft Rejection - epidemiology; Graft Survival; Humans; Immunohistochemistry; Intraoperative Care - methods; Kaplan-Meier Estimate; Kidney Transplantation - adverse effects; Kidney Transplantation - methods; Kidneys; Male; organ allocation; Prognosis; protocol biopsy; Registries; Retrospective Studies; Statistics, Nonparametric; Survival Rate; Tissue and Organ Procurement - methods; Tissue Donors - statistics & numerical data; Transplant Recipients - statistics & numerical data; Transplants & implants; Treatment Outcome; United Kingdom; Donors and donation: donation after circulatory death (DCD); organ allocation; protocol biopsy
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.13349

Most kidneys from potential elderly circulatory death (DCD) donors are declined. We report single center outcomes for kidneys transplanted from DCD donors over 70 years old, using preimplantation biopsy Remuzzi grading to inform implantation as single or dual transplants. Between 2009 and 2012, 43 single transplants and 12 dual transplants were performed from elderly DCD donors. Remuzzi scores were higher for dual than single implants (4.4 vs. 3.4, p < 0.001), indicating more severe baseline injury. Donor and recipient characteristics for both groups were otherwise similar. Early graft loss from renal vein thrombosis occurred in two singly implanted kidneys, and in one dual‐implanted kidney; its pair continued to function satisfactorily. Death‐censored graft survival at 3 years was comparable for the two groups (single 94%; dual 100%), as was 1 year eGFR. Delayed graft function occurred less frequently in the dual‐implant group (25% vs. 65%, p = 0.010). Using this approach, we performed proportionally more kidney transplants from elderly DCD donors (23.4%) than the rest of the United Kingdom (7.3%, p < 0.001), with graft outcomes comparable to those achieved nationally for all deceased‐donor kidney transplants. Preimplantation biopsy analysis is associated with acceptable transplant outcomes for elderly DCD kidneys and may increase transplant numbers from an underutilized donor pool. This study shows that the use of microscopic and macroscopic characteristics to guide the choice between single or dual kidney implantation from circulatory death donors over the age of 70 achieves acceptable outcomes.