*Purpose: Kidney allocation has recently been modified to allow enhanced utilization of dual kidney transplants (DKT) to reduce organ discards. This study evaluates surgical complications and transplant outcomes in a group of preselected kidney transplant candidates (KTC).

*Methods: This study covers a period of 5 years between January 1, 2015 and December 1, 2019. At our institution, we have screened our waitlisted KTC for potential DKT. Selection criteria are chosen to optimize benefit , shorten operating time and limit surgical complications. Inclusion Criteria: Age >50 years, BMI <30, Height >170 cm, Exclusion criteria : Significant cardiopulmonary impairment (positive cardiac stress test, coronary revascularization, low ejection fraction <35%, hypotension, limited effort tolerance), significant bilateral iliac artery calcifications, narrow pelvis , symptomatic peripheral arterial disease .Case by case review was performed for peritoneal dialysis, re-transplants, hernia repairs with mesh, polycystic kidneys (PKD), CPRA>90%, lower extremity amputees, preemptive transplantation.

*Results: In the study period, we performed 22 dual kidney transplants. 6/22 were preemptive, 3/22 were second transplants. 5/22 recipients had PKD without prior nephrectomy. All the kidneys were placed through a single incision and completed as planned. 21 kidneys were placed on the the right iliac vessels , while 1 pair was placed on the left. DGF was seen in 14/22 (63%) DKT. 7/22 patients were female. 2 patients (9%) required reoperation ( 1 hematoma evacuation for bleeding, and 1 graft venous thrombectomy and subsequent allograft nephrectomy for renal vein thrombosis). 1 patient developed an incisional hernia after primary closure with a vicryl mesh to prevent a compartment syndrome while 2 patients developed an ipsilateral inguinal hernia (3/22 or 13%) with one patient having neuropathic pain in the right thigh. There was one Candidal infected lymphocele in the patient after left single allograft nephrectomy. 7/22 (31.8%) patients had ipsilateral edema requiring diuretics. There were no urologic complications, deep venous thrombosis or cardiovascular events related to transplantation. Median follow up was 730 days (60-1460). Mean GFR was 58.3±25.9 ml/min, 1 year death censored graft survival was 100% and patient survival was 95.4% (1 death due to a glioblastoma).

*Conclusions: Recipient selection based on body habitus and cardiopulmonary status is key to successful DKT. Left sided DKT may increase the risk of a compartment syndrome and renal vein thrombosis. Ipsilateral hernias and limb edema are the most common surgical complications. Relative recipient contraindications to DKT are easy to assess and relatively few in number.

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