Dual kidney transplantation, report of a case and review of the literature

Abstract

Background: Kidney transplant is the best replacement therapy for kidney function; However, donors are insufficient, so extended criteria donors (ECD) are needed, which, in well-selected recipients, provide better survival than being on dialysis. Dual kidney transplantation (DRT) should be offered to elderly patients with lower immunological risk and with a lower body mass index. DCE are considered donors who died due to stroke, ≥ 60 years old or aged between 50 and 59 years, with diabetes or previous hypertension, clinical proteinuria, estimated glomerular filtration rate (eGFR) between 30 and 60 mL/min, or Terminal serum creatinine > 2.5 mg/dL.

Clinical case: 57-year-old male patient undergoing TRD of a 67-year-old DCE, with creatinine of 2 mg/dL at the time of extraction, without previous pathologies, with eGFR: 34 mL/min, KDPI: 92% , KDRI: 1.64, Remuzzi pre-implantation biopsy 5, with 14-hour cold ischemia. He was discharged on the eighth day with a creatinine of 1 mg/dL. At 45 months with creatinine of 0.9 mg/dL, and eGFR by CKD-EPI of 91 mL/min/ 1.73m2.

Conclusion: TRD is an alternative for ECD grafts. The “old for old” strategy allows TRD in older recipients a better survival than being on replacement treatment. The correlation with the KDRI, KDPI scales and the preimplantation biopsy according to the Remuzzi score improves transplant results by discarding kidneys with severe histopathological alterations, this can help reduce the rate of discarding SCAD and kidneys.