Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom

Abstract

Background and objectives: Kidneys from elderly deceased donors are often discarded after procurement if the expected outcomes from single kidney transplantation are considered unacceptable. An alternative is to consider them for dual kidney transplantation. We aimed to examine the utilization of kidneys from donors aged ≥60 years in the United Kingdom and compare clinical outcomes of dual versus single kidney transplant recipients.

Design, setting, participants, & measurements: Data from the United Kingdom Transplant Registry from 2005 to 2017 were analyzed. We examined utilization rates of kidneys retrieved from deceased donors aged ≥60 years, and 5-year patient and death-censored graft survival of recipients of dual and single kidney transplants. Secondary outcomes included eGFR. Multivariable analyses and propensity score analysis were used to correct for differences between the groups.

Results: During the study period, 7841 kidneys were procured from deceased donors aged ≥60 years, of which 1338 (17%) were discarded; 356 dual and 5032 single kidneys were transplanted. Donors of dual transplants were older (median, 73 versus 66 years; P<0.001) and had higher United States Kidney Donor Risk Indices (2.48 versus 1.98; P<0.001). Recipients of dual transplants were also older (64 versus 61 years; P<0.001) and had less favorable human leukocyte antigen matching (P<0.001). After adjusting for confounders, dual and single transplants had similar 5-year graft survival (hazard ratio, 0.81; 95% CI, 0.59 to 1.12). No difference in patient survival was demonstrated. Similar findings were observed in a matched cohort with a propensity score analysis method. Median 12-month eGFR was significantly higher in the dual kidney transplant group (40 versus 36 ml/min per 1.73 m²; P<0.001).

Conclusions: Recipients of kidneys from donors aged ≥60 years have similar 5-year graft survival and better graft function at 12 months with dual compared with single deceased donor kidney transplants.

Keywords: deceased donor; kidney donation; kidney donor; kidney transplantation; organ transplant; renal transplantation; survival; transplant outcomes; transplantation; utilization.

Graphical abstract

Figure 1.

The percentage of kidneys retrieved from United Kingdom deceased donors aged ≥60 years that were discarded over the study time period has remained fairly stable. The absolute number of kidneys retrieved and number of kidneys discarded from donors aged ≥60 years and above are depicted in the table.

Figure 2.

Line graph and table showing the increasing number of dual kidney transplants performed from donors aged ≥60 years in the United Kingdom from 2005 to 2014, followed by a decline in recent years. The median dual transplant donor age has gradually increased. IQR, interquartile range.

Figure 3.

No significant difference in 5-year death-censored graft survival of single versus dual kidney transplants from deceased donors aged ≥60 years, 2005–2017.

Figure 4.

No significant difference in 5-year patient survival of single versus dual kidney transplants from donors aged ≥60 years, 2005–2017.

Figure 5.

In a propensity score matched cohort, 5-year death-censored graft survival of single and dual kidney transplants from deceased donors aged ≥60 years remains similar.