OUTCOMES OF DUAL KIDNEY TRANSPLANTATION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Marginal kidneys have gained progressive acceptance with the use of extended criteria donor (ECD) kidneys, however there still remains high discard rates of these allografts. Increasing the donor pool can be accomplished through allocation for dual kidney transplantation (DKT) which has shown comparable outcomes to those from single kidney transplantation (SKT). This study analyzed the outcomes of DKT compared to SKT from marginal kidneys.
Electronic databases including MEDLINE, EMBASE, PubMed and Cochrane library were searched using Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Each paper included was reviewed in duplicate. Patient factors including mean age of donors and recipients, gender and length of follow up was analyzed. The outcome measures analyzed included the cold ischemia time, graft survival, patient survival, serum creatinine in follow up and delayed graft function (DGF) in DKT compared to SKT.
17 publications were selected after inclusion criteria verification. Studies were heterogeneous, non-randomized and retrospective. Delayed graft function was lower in the DKT group as per weighted means. Graft survival was greater in DKT after 1 year (OR = 1.64, 95% CI 1.10 - 2.45, p = 0.02). There was no significant difference in patient survival after one year in DKT compared to SKT (OR = 1.34, 95% CI 0.72 - 2.49, p = 0.36). Serum Cr was better in the DKT group after pooled estimates (Mean Difference = - 0.35, CI -0.54 - -0.17, p = 0.0002). Long-term outcomes at 1-2 years and 3-4 years also significantly favoured DKT with respect to graft survival (OR = 1.55, 95% CI 1.21 - 1.98, p = 0.0004) and patient survival (OR = 1.37, 95% CI 1.05 - 1.78, p = 0.02).
DKT with marginal kidneys results in greater short term outcomes with respect to graft survival and function. Long-term outcomes are also favourable for DKT over SKT. Therefore, marginal kidneys that would otherwise be discarded should be considered for DKT which can reduce morbidity, mortality and time on wait lists for older patients with end stage renal disease.