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The number of available donated kidneys often falls significantly short in comparison to the protracted waiting periods endured by transplant recipients in certain regions, which a long waiting time. Concurrently, kidney discard rates persist due to diverse evaluative criteria. The dual kidney transplantation may represent a viable strategy to harmonize organ demand and supply.
A 63-year-old man with a past medical history significant for end-stage kidney disease (ESKD) of unknown etiology initiated hemodialysis 3 years ago. While the average waiting time for kidney transplantation in this transplant region is 8 to 10 years, the decline of this “marginal” kidney offer from other transplant centers allowed the patient to receive this organ offer despite his short waiting time of 3 years. He then underwent an A-to-A compatible, risk-criteria donor, 5-A-B-DR mismatched antigen (matched B7), deceased donor kidney transplantation from both kidneys with a kidney donor profile index (KDPI) of 87%. Relevant donor characteristics included a middle-aged adult with diabetes, hypertension, and old cerebrovascular accident who was admitted for intracranial hemorrhage. The donor's initial serum creatinine on admission was 2.65 mg/dL with a peak and terminal serum creatinine level prior to organ procurement of 10.3 mg/dL.The transplant operation involved the transplantation of both kidneys with right and left allografts placed superiorly and inferiorly in the right lower quadrant retroperitoneal space, respectively (Figure 1). The patient's immunosuppressive regimen consisted of induction with thymoglobulin 5 mg/kg and ongoing maintenance with tacrolimus, mycophenolate sodium, and prednisolone. He had immediate kidney allograft function. Post-transplant course was uneventful with a baseline serum creatinine of 1.3 - 1.5 mg/dL at four-month post-transplant (Figure 2).
Results
This case represents an efficient means of organ utilization while respecting the altruistic intentions of posthumous kidney donors. Simultaneously, it expedites kidney transplantation, a particularly advantageous development for elderly recipients, as it aligns graft survival and life expectancy; otherwise, this patient might continue be on the transplant waiting list for an additional 5 to 7 years before receiving an organ offer or even death on the waitlist. The avoidance of protracted dialysis mitigates cardiovascular strain. Nonetheless, a prolonged wait for a suitable kidney may render a recipient unsuitable for transplantation. Thus, this approach demonstrates mutual benefits and resource management efficacy, mitigating organ shortage which has been chronic, persistent, and ongoing
The utilization of dual kidney transplantation emerges as a game-changer, facilitating earlier transplant access, particularly in areas which an extended organ wait time. As exemplified in this case study, even though the “marginal” kidneys were transplanted, the transplant outcomes are favorable.