The purpose of this study was to review retrospectively our single center experience with adult dual kidney transplants (DKT) from marginal donors with limited nephron mass.

Methods: If the calculated creatinine clearance in an adult deceased donor was <65 ml/min, then the kidneys were transplanted as a DKT. Low risk patients (pts) were chosen and informed consent was obtained. All pts received antibody in combination with FK, MPA, +/- steroids. Results: From 11/01-9/12, 69 DKTS were performed including 44 from expanded criteria donors (ECDs), 17 from donation after cardiac death (DCD) donors, and 8 from standard criteria donors (SCD); 7 dual kidneys were transplanted from donors with acute kidney injury. Mean donor and recipient ages were 60 and 59 years, respectively, including 15 donors and 14 recipients ≥70 years of age. Mean pretransplant waiting and dialysis vintage times were 12 months and 24 months, respectively. Actual pt and graft survival rates were 87% and 74%, respectively, with a mean follow-up of 41 months. One year and death-censored kidney graft survival rates were 90% and 82%, respectively. Outcomes did not differ by donor source or recipient age. The incidence of delayed graft function (DGF) was 25% and there were 2 cases (3%) of primary nonfunction. Mean length of initial hospital stay was 7.6 days. The incidence of surgical complications, acute rejection, and major infection were each 17%. Mean serum creatinine (SCr) and aMDRD GFR levels at 1, 12, and 24 months were 1.7 and 48, 1.6 and 52, and 1.5 mg/dl and 51 ml/min, respectively. In the absence of DGF or AR, the proportionate nephron mass transplanted from donor to DKT recipients was 77% compared to 55-58% for pts receiving single kidneys from SCD, ECD, and DCD donors. Conclusions: DKT using kidneys from marginal donors that otherwise might be discarded offer a viable option to counteract the growing shortage of acceptable single kidneys. Excellent medium-term outcomes can be achieved with limited nephron mass donors provided that both kidneys are transplanted into an appropriate recipient.

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