BERKELEY, CA (UroToday Inc.) - With both the increasing need for renal transplantation and the increasing age of donors, it is imperative to determine which kidneys are suitable for transplantation.

Rigotti and colleagues from Padova, Italy review their experience with elderly donors and single and dual kidney transplants, looking especially at the relationship between donor characteristics and recipient outcomes and analyzing the role of renal biopsy in donor evaluation. They report their results in the August 2004 edition of Clinical Transplantation.

They retrospectively reviewed their experience with 84 cadaveric donors who were aged sixty years or older. Renal biopsies were performed in all kidneys after harvesting. Renal tissue was scored on a scale from 0-12 after being examined for glomerulosclerosis, tubular atrophy, interstitial fibrosis, arterial and arteriolar narrowing. Higher scores indicated poorer renal tissue. Those kidneys that scored 0 to 3 were used for single transplants (ST), 4 to 6 were used for dual kidney transplant (DKT), and greater than six were discarded.

Twenty-six donors were not used because of severe atherosclerotic lesions of the renal arteries, voluminous cysts or significant abnormalities after renal biopsy. Of the seven kidneys discarded after renal biopsy, 3 had a histologic score greater than six, 2 had neoplastic nodules, one had pyelonephritis, and one had diabetic nephropathy.

Forty patients underwent ST and 21 patients underwent DKT. Four ST patients died subsequently, two in the perioperative period associated with non-functioning kidneys, one 3 months after transplantation secondary to sepsis, and one 15 months after transplantation due to leukemia. All in the DKT group are alive.

There were 2 graft losses in the ST group (one primary non-function and one acute rejection) and 3 in the DKT group (one primary non-function, one acute rejection, and one chronic allograft nephropathy). Acute tubular necrosis occurred in almost 50% of the ST and DKT groups. The incidence of acute rejection in the ST group was 40% while in the DKT groups it was 19%. Both groups developed satisfactory renal function after one year. The one-year graft survival was 89% in the ST group and 95% in the DKT group.

Dual kidney transplant allows use of elderly donor kidneys with ultimate good graft survival and good renal function. Prior renal biopsy with histologic evaluation may prove crucial in helping to increase the number of patients with good functional transplants.

Clin Transplant 2004; 18: 440-445