Indications et résultats de la bi-transplantation rénale : un outil dans la lutte contre la pénurie d'organes

By using organs from expanded criteria donors (ECD) judged inadequate for single transplantation, dual kidney transplantation (DKT) aims to increase the deceased donor organ pool and optimize the use of marginal allografts. In France, recipients must be aged 65 and more, have less than 25 % panel reactive antibodies and be clearly informed about DKT. Donors age is superior to 65 years, with estimated glomerular filtration rate (GFR) comprised between 30 and 59 ml/min, and history of hypertension, diabetes mellitus, cardiovascular disease or deceased from a cerebro-vascular stroke. As these criterias are not prospectively validated, main intricacy is sometimes to decide if one allograft should be attributed for single or dual kidney transplantation. DKT results, in terms of graft survival, are similar to single transplantation of ECD kidneys, and even, for some authors, similar to standard single transplantation, although it seems that the risk for medical adverse events and vascular thrombosis is increased. To expand DKT in french transplant centers, and therefore to lower cold ischemia time, it is mandatory to improve donors as well as recipients selection and to develop innovative techniques in the field of organ conservation and perfusion; thus, expansion of DKT will contribute to alleviate organ shortage.