Changes in national kidney allocation are anticipated to begin in 2014. The proposed system redefines ECD kidneys, resulting in a reduction in both the quantity and quality of ECD kidneys being offered. This is predicted to reduce the number of kidney transplants in elderly candidates. Currently, as many as 40% of ECD kidneys are discarded. Many of these could be utilized as dual kidney transplants. Reducing the number of discarded kidneys through dual transplantation could address the anticipated dropoff in ECD transplants. We report on our experience with 19 dual kidney transplants over the past four years.

Since March of 2008, we have performed 19 dual kidney transplants. All kidneys were turned down by local programs for transplantation singly. All kidneys were cold stored with UW solution. 16 of 19 transplants had immediate function.

Recipients were treated with Thymoglobulin induction (3 mg/kg unsensitized; 6 mg/kg sensitized) followed by triple drug immunosuppression with Prograf, Cellcept and Prednisone. Average length of stay was 6 days.

Patient and graft survival and graft function compare favorably to ECD kidneys transplanted singly, despite utilizing donors with higher KDPI's. One patient lost his transplant from gross noncompliance; this was the only case in which rejection was diagnosed. Another transplant failed from deep space wound infection; the patient died on dialysis two years later from heart disease and lymphoma.

Dual kidney transplantation is a viable option to reduce the impact of allocation changes that are predicted to reduce access to transplantation for elderly candidates.

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