Dual Kidney Transplantation: A Review of Past and Prospect for Future

Table 4

Outcome of DKT.

Author	Journal/year/number Of DKT	Number and surgical technique/Immunosuppression for DKT	Delayed graft function		Acute rejection		Graft survival/kidney function (creatinine or GFR)		Patient survival
			DKT	SKT	DKT	SKT	DKT	SKT	DKT	SKT
Johnson et al. [42]	Transplantation/1996; Surgery/1996	Six paired kidneys were placed intraperitoneally, while the remaining four pairs were placed in bilateral retroperitoneal iliac fossa locations/no comment on immunosuppressive medications	—	—	—	—	Overall graft survival of 90.0% and actuarial 1-year graft survival of 83.3%. (no death occurred in cohort)	—	—	—
Johnson et al. [15]		Dual kidneys were transplanted intraperitoneally or through bilateral extraperitoneal incision/Induction was either with ATG or OKT3 followed by cyclosporine, AZA and prednisolone	—	—	—	—	Graft survival at 6 month in dual was 100% (no death till 6 month) in <50 years cadaveric kidney donor and 75% graft t survival (no comment whether death censored or not) in recipient who got kidney from cadaveric donor age > 60 years	62.5 ± 5.4 & 24.5 ± 5.3 ml/minute in age < 50 & age > 60. Graft survival 95% in age < 50 & 75% survival in age > 60 years	100% in recipient of cadaveric kidneys from less than 50 year & 83% from donor greater than 60 years	95%  &  83%; at 6; months; in age < 50; & age > 60 years
Alfrey et al. [43]	Transplantation/1997	20 DKT as two single kidneys on the back table. Through a midline incision the iliac vessels were exposed via extraperitoneal dissection/all patients received cyclosporine-based triple-drug therapy	9%	45%			87% survival at 1 year (nondeath censored. Graft loss defined as return to dialysis or death)	Cr 2.8 ± 2.0 mg/dl at 4 weeks & 81% survival at 1 year	Cr .4 ± 0.5 mg/dl at 4 weeks & 93% survival at 1 year	96%; survival at 1 year
Stratta and Bennett [44]	Transplant Proc/1997	60 DKT (25 young donors 35 old donors)/No comments on surgical teqhnique or immunosuppressive medications used	—	—	—	—	90.8% 1 year survival (No comment whether death censored or not)	87.5% 1 year survival	—	—
Lu et al. [20]	Archives of Surgery/1999	50 bilateral placement in right and left iliac fossa via midline extra peritoneal approach/Cyclosporine, steroids & MMF or AZA. Induction with OKT3 or IL-2 inhibitor	26%	39%	0.2 ± 0.5	0.7 ± 0.9	Death censored graft survival at 2 years was 85%	Death censored graft survival at 2 years was 84%. years in ECD SKT and 86% in control single	86% 2-year survival	96% 2-year survival
Remuzzi et al. [16]	Journal of American Society of Nephrology/1999	24 bilateral placement through double inguinal incision/Prednisolone, Cyclosporine & mycophenolate mofetil. No comment on induction	20.8%	20.8%	20.8%	18.8%	Cr 1.5 ± 0.4 mg/dl & 100% Survival at 6 months (no death till follow-up)	Cr 1.9 ± 0.7 mg/dl 100% Survival at 6 months	100% Survival at 6 months	100% survival at 6 months
Jerius et al. [33]	Journal of Urology/2000	28 kidneys were placed bilaterally or unilaterally using standard right and left lower quadrant extraperitoneal approaches/4 patients receiving pancreas received OKT3 induction. Triple drug immunosuppression consisted of cyclosporine or tacrolimus, azathioprine or mycophenolate mofetil and prednisone was used	6 out 28 cases	7 out of 31 cases	—	—	In an intent to treat analysis with inclusion of all patients 1 and 2-year graft survival rates were 93% and 86%. These differences were not statistically significant. The data were then adjusted to eliminate nongraft dependent loss factors. The patient in each group with loss due to subacute humoral rejection was excluded from analysis. The graft loss due to patient noncompliance in group 1 was treated as censored data at the time of loss instead of graft failure. With these adjustments 1- and 2-year graft survival rates for DKT were 96% and 96% which was significantly better than SKT	1- and 2-year graft survival rates of 77% and 73%	—	—
Lee et al. [32]	Journal of American College of Physician/1999	41 dual kidneys were procured in the usual fashion and were prepared as 2 single kidneys on the back table. Through a midline incision the iliac vessels were exposed by extraperitoneal dissection; one kidney was anastomosed to the left iliac vessels, and the other to the right iliac vessels/the majority of the recipients transplanted received cyclosporine based triple therapy that included mycophenolate mofetil and prednisone	24%	33%	—	—	GFR at 1 year 54 ± 23 ml/min & 1 year graft survival 89% (graft loss defined as permanent return to dialysis)	GFR at 1 year 57 ± 25 ml/min 1-year graft survival 90%	1-year patient survival 97%	1-year patient survival 98%
Gill et al. [18]	Transplantation/2008	625 received DKT/no comment on surgical technique or immunosuppression	29.3%	33.6% ECD	12.1% at 1 year	17.6% at 1 year	Death-censored allograft survival of DKT and ECD transplants were not significantly different up to 4 years after transplant	Death-censored allograft survival of DKT and ECD transplants were not significantly different up to 4 years after transplant	—	—
Snanoudj et al. [24]	American Journal of Transplantation/2009	81 monolateral or bilateral placement with one or two classical iliac incisions/received IL-2 receptor antagonist or ATG. Cyclosporine or tacrolimus, prednisolone and MMF were used after induction	31.6%	51.4% (Significant)	12.3% at 1 year	34.3% at 1 year	Kaplan–Meier estimates of non-death-censored graft survival up to 3 years similar	Kaplan–Meier estimates of non- death-censored graft survival up to 3 years similar	Kaplan–Meier estimates of patient survival similar up to 3 years	Kaplan–Meier estimates of patient survival similar up to 3 years
Frutos et al. [21]	Nefrologia/2012	20 bilateral Kidney placement through 2 independent incisions in each of the recipient’s iliac fossae/induction with basiliximab + prednisolone, tacrolimus & MMF	30%	35%	—	—	GFR at 1 year 55.0 ± 18.5. Graft survival at 3 years was 90% (not death censored).	GFR at 1 year 51.3 ± 6.2	—	—
Ekser et al. [19]	American Journal of Transplantation/2010	100 unilateral extraperitoneal placement via Gibson incision/Induction therapy consisted of antithymocyte globulin (ATG) or basiliximab.; Maintenance immunosuppressive sirolimus or everolimus either without a calcineurin inhibitor (CNI) or with a reduced CNI	31%	30%	17%	28%	Actuarial Kaplan–Meier graft survival curves at 5-year follow-up was 90.9% (no comment about death censored or not death censored)	4 GFR at 5 year 9 ± 13 (12 patients)	5-year patient survival, 95.6%	5-year patient survival, 87.3%
Islam et al. [22]	Journal of Transplantation/2016	29 extraperitoneal placement in right iliac fossa through curvilinear incision/high risk recipients received ATG and the rest either daclizumab or basiliximab.; Maintenance immunosuppression consisted of tacrolimus, MMF, and prednisone	10.3%	9.2%	20.7%	22.4%	Median e GFR (IQR) at 36 months 45.9 ml/minute (36.8–62.6). Actuarial graft survivals 93% at 3 years (No death occurred in this cohort)	Median e GFR (IQR) at 36 months 56.7 (43.7–71.8)	Actuarial patient survivals 100% at 3 years

. IL-2 (interleukin-2), ATG (antithymocyte globulin), MMF (mycophenolate mofetil), AZA (azathiopurine), CNI (calcineurin inhibitors), ECD (extended criteria donor), e GFR (estimated glomerulofilteration rate), and GFR (glomerulofilteration rate).