*Purpose: In the United States, over 91,000 people are on the waiting list for a kidney transplant. Concurrently, 3,500 kidneys deemed to be of marginal quality are discarded per year. “Two-for-One” kidney transplants use two marginal kidneys for a single recipient to provide adequate nephron mass. The purpose of this study was to evaluate outcomes with Two-for-One kidney transplants performed nationally compared with outcomes at a single center.

*Methods: We conducted a retrospective cohort study of all consecutive adult kidney transplants performed from January 2012 to April 2020. National data and our local center data were analyzed separately. We compared outcomes in single kidney transplants (KT) compared with two-for-one KT in both data sets. National data was obtained from the United Network for Organ Sharing (UNOS) and our local center data was collected from the electronic medical records.

*Results: Nationally there were 248,755 kidney transplants with 2,501 (1%) two-for-one KT. Our center performed 1,455 kidney transplants with 38 (2.6%) two-for-one KT during the study period. The mean national donor age was 38 vs. 57 years for single KT and two-for-one KT respectively, (p<0.001) compared with a mean age of 19 vs.38 years at our local center (p<0.001). The national recipient mean age was 50 vs.59 years for single KT and two-for-one KT respectively, (p<0.001) compared with our local center recipient mean age of 33 vs. 58 years (p<0.001). Nationally, there was a statistical difference in delayed graft function between the single KT (25%) compared with two-for-one KT (30%), p<0.001. There was no difference in delayed graft function between the two groups at our center, single KT (17%) vs. two-for-one KT (18%), p=1.00. Nationally, single KT had better graft survival than two-for-one KT (p<0.001), while there was no difference at our center, p=0.32. Patient survival at the national level was significantly improved for single KT vs. two-for-one KT (p<0.001), whereas there was no difference in patient survival in our center’s data (p=0.82).

*Conclusions: Two-for-one kidney transplants are a viable means of expanding the organ donor pool, however patient and graft survival differ between the national and local center data. These findings suggest disparities between both the quality of organs and recipient selections. Further studies of donor and recipient comorbidities and risk factors are warranted to facilitate greater utilization of two-for-one kidney transplants.

« Back to 2021 American Transplant Congress