Abdulghani Abou Koura, Alex Judd, Stephanie Silpe, Juan F Guerra, Danielle Ladie, Kenneth Brayman, Shawn J Pelletier, Yazan Al-Adwan
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引用次数: 0
Abstract
Background: Hard-to-place kidneys remain underutilized despite ongoing organ shortage. Dual kidney transplantation (DKT) may improve use of these grafts, but contemporary national data are limited.
Methods: We performed a retrospective cohort study using national databases from March 2015 to December 2024. Outcomes after DKT and single kidney transplantation (SKT) were compared in the overall cohort and after 2:1 propensity score matching (PSM) using Kaplan-Meier, Cox, and logistic regression.
Results: A total of 140,707 deceased donor kidney transplants were analyzed, including 1,236 (0.9%) DKT. In the overall cohort, DKT was associated with lower graft and patient survival. After 2:1 PSM, 1,105 DKT recipients were matched to 2,210 SKT recipients with balanced recipient age (63.7 vs 63.9 years) and KDPI (75.5 vs 75.8; SMD <0.03). After PSM, DKT was associated with higher 1-, 3-, and 5-year graft survival (92.2%, 81.8%, and 69.8% vs 87.7%, 75.5%, and 59.9%; all P < 0.001), while DGF rates were similar.
Conclusion: DKT remains an uncommon but important strategy for utilization of hard-to-place donor kidneys. After matching recipients with comparable age and KDPI, DKT was associated with favorable graft and patient survival and similar DGF rates, supporting selective use in carefully chosen recipients.
背景：尽管器官短缺，但难以安置的肾脏仍未得到充分利用。双肾移植（DKT）可以改善这些移植物的使用，但当代国家数据有限。方法：2015年3月至2024年12月，我们使用国家数据库进行回顾性队列研究。采用Kaplan-Meier、Cox和logistic回归对DKT和单肾移植（SKT）后的结果进行整体队列和2:1倾向评分匹配（PSM）后的结果进行比较。结果：共分析死亡供肾移植140707例，其中DKT 1236例（0.9%）。在整个队列中，DKT与较低的移植物和患者生存率相关。2:1 PSM后，1105名DKT受者与2210名SKT受者匹配，受者年龄（63.7 vs 63.9岁）和KDPI （75.5 vs 75.8）平衡；SMD结论：DKT仍然是一种罕见但重要的策略，用于利用难以放置的供肾。在匹配年龄和KDPI相当的受体后，DKT与良好的移植物和患者生存率以及相似的DGF率相关，支持在精心选择的受体中选择性使用。
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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