Kidney transplants from expanded criteria donors (ECD) have become generally accepted due to the increasing organ shortage. Dual kidney transplantation (DKT) of marginal kidneys not suitable for single kidney transplantation (SKT) is a possibility to further expand the donor pool. Still, DKT remains underused and potentially eligible kidneys are often discarded. Two kidneys can be allocated to one recipient by Eurotransplant rules if donor age is above 75 or the GFR is below 75ml/min, but not by histology.

To evaluate whether DKT can be performed savely without allocation by histological scores, we analysed outcomes of DKT in our center and compared them to SKT and to an ideal kidney transplantation (IKT), a living donor kidney transplantation with older donors and recipients.

To this end, we retrospectively analysed 12 DKT and 23 SKT which were matched by recipient age, HLA matches and ischemia time. 13 patients were in the IKT group. The follow up period was 12 months. Quality of life (QoL) was assessed with a questionaire. Statistical analyses were performed by one way ANOVA, Chi2 and student's t-test.

Donor age and creatinine was significantly higher in DKT compared to SKT and IKT. Patient survival was 100% in all groups. No graft was lost during follow-up in the IKT and DKT group, but one in SKT. Duration of hospitalization was similar and no difference in renal function at discharge was observed between DKT and SKT, with a trend towards more delayed graft function in DKT. Best-creatinine in the follow-up period was also not significantly different in all three groups. DKT patients were significantly longer on ICU, received more blood transfusions and were re-operated more often compared to SKT and IKT. Rejection episodes were lower in DKT compared to IKT and SKT, potentially due to the more frequent use of tacrolimus in DKT. QoL was not affected by DKT.

In conclusion two marginal kidneys allocated by GFR and careful recipient selection but not histological scores can be performed safely and successfully. Although surgical complications are increased, patient and graft survival as well as renal function are not different compared to SKT and to IKT. Although a larger cohort and longer follow up is needed, our results suggest that DKT can be used to transplant kidneys which otherwise might have been discarded.

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