Outcomes in Dual Kidney Transplantation with Kidneys with Remuzzi Scores of ≥8

The Remuzzi score is a histologic assessment of donor kidneys based on degree of glomerulosclerosis, arterial narrowing, interstitial fibrosis, and tubular atrophy. Allocation of renal allografts can be guided with the Remuzzi score for both single and dual kidney transplantation.

Previous studies have shown that outcomes of dual kidney transplantation using kidneys with combined Remuzzi score of 5 to 12 are similar to outcomes of single kidney transplantations with Remuzzi score <5. Recommendations based on the previous studies call for dual kidney transplantation with combined Remuzzi score of up to 12. The outcomes of dual kidney transplantation with combined Remuzzi score >12 are uncertain.

V. Fleetwood and colleagues conducted a single-center retrospective review to assess whether outcomes after dual kidney transplantation are impacted by higher Remuzzi scores. Results of the review were reported during a virtual poster session at the American Transplant Congress 2020 in a poster titled Is Dual Allocation Successful at Higher Remuzzi Scores? Outcomes of Dual Kidney Transplants at Remuzzi Scores of 8 or Greater.

The analysis included 65 recipients of dual kidney transplantation from 2000 to 2015. Sixty of the 65 (92.3%) had complete biopsy data. The analysis was stratified by Remuzzi score: low (2-5, n=10), intermediate (6-8, n=29), and high (9-14, n=21). ANOVA was used to compare mean estimated glomerular filtration rates (eGFRs). Graft survival and patient survival were determined using Kaplan-Meier estimates; survival rates were compared with the log rank test.

In the low and intermediate Remuzzi score groups, eGFR increased at 3 and 5 years but did not improve in the high Remuzzi score group (Table). At 3 years, death-censored graft survival appeared better in recipients of low Remuzzi score, but was similar between the intermediate and high Remuzzi score groups (90.0% in the low group versus 75.7% and 73.0% in the intermediate and high Remuzzi score groups, respectively; P=.077).

Table: Estimated GFR Over Time

GFR1 year3 years5 years
Low59.365.367.7
Intermediate51.154.963.5
High51.550.153.4

After 3 years, patient survival was higher in the low-risk group but similar in the intermediate and high-risk groups (P=.37) for up to 10 years.

In conclusion, the authors said, “The use of kidneys with high Remuzzi score for dual kidney transplantation is safe and effective, with similar death-censored graft survival and patient survival in intermediate and high Remuzzi score. At 5 years, eGFR is higher in intermediate Remuzzi score recipients than high Remuzzi score recipients; intermediate Remuzzi score recipients may develop better filtration ability over time than high Remuzzi score recipients. Despite having lower filtration, the high-risk group has similar graft survival and patient survival outcomes and is therefore appropriate for use.”

Source: Fleetwood V, Kensinger C, Papageorge C, et al. Is dual allocation successful at higher Remuzzi score? Outcomes of dual kidney transplants at Remuzzi scores of 8 or greater. Abstract of a poster presented at the virtual American Transplant Congress 2020 (Abstract B-036), May 30, 2020.