Single Versus Dual Kidney Transplants From Marginal Donors: Balancing Survival and Resource Utilization

With population aging and increasing prevalence of kidney disease, a greater number of older patients could benefit from a kidney transplant. Organ shortage has led to expanding the pool of potential donors, including both kidneys from the same donor as dual transplants into a single recipient. At present, there is no consistent criteria for determining suitability for single versus dual transplant.

We performed a retrospective analysis of the Organ Procurement and Transplantation Network database of all recipients undergoing single or dual kidney transplants from deceased donors from December 4, 2014, to March 31, 2024, excluding en bloc donors. We examined patient and graft survival rates and graft function in dual versus single kidney transplantation. In addition, we analyzed potential survival differences between using a single kidney transplantation over dual transplantation.

During the study period, there were a total of 1015 dual kidney transplant recipients and 134,933 single kidney recipients. The donors of the dual transplants were older, had higher KDRI, and had increased rates of glomerulosclerosis, with > 20% glomerulosclerosis seen in 20% of the kidneys. Using 3:1 propensity matching, we did not observe a significant difference in overall patient survival. We did observe a significant increase in graft survival with dual transplants. Transplanting all dual kidneys as single kidneys could result in a 0.9% increase in overall successful transplants and a 3% reduction in waitlist deaths.

Careful donor and recipient matching are crucial to optimize outcomes in this population. More emphasis needs to be placed on maximizing survival benefit from each donor kidney.