Experience with dual kidney transplants from donors at the extremes of age

Background. Dual kidney transplantation (DKT) from donors at the extremes of age represents one approach to expanding the organ donor pool. The purpose of this study was to review our experience with DKT from older donors and en bloc KT (EBKT) from small pediatric donors. Methods. Deceased donor KTs performed at our center between October 2001 and November 2005, were reviewed retrospectively. If the calculated creatinine clearance in an expanded criteria donor was < 65 mL/min, then the kidneys were transplanted dually into a single adult recipient. If a pediatric donor weighed < 15 kg, then the kidneys were transplanted en bloc. In both instances, low-risk recipients were chosen (primary transplant, low sensitization, body mass index < 25 kg/m(2) human leukocyte antigen matching). Donor, recipient, and transplant characteristics, waiting time, and outcomes were examined. Results. Of a total of 2 79 deceased donor KTs during the 49-month study period, 15 (5 %) recipients underwent DKT and 5 (2 %) underwent EBKT Mean donor age was 65.4 years and 21.4 months in the DKT and EBKT groups, respectively. Patient survival rates in both groups were 100 % with a mean follow-up of 22 months (minimum, 6 months). Kidney graft survival rates were 80 % (12115) and 60 % (315) in the DKT and EBKT groups, respectively. The combined incidence of delayed graft function was 10%. Mean 12-month glomerular filtration rates were 46 mL/min and 66 mL/min in the DKT and EBKT groups, respectively. Conclusions. DKT using kidneys from marginal elderly donors and EBKT from small pediatric donors appear to offer a viable option to counteract the shortage of acceptable kidney donors.