Dual Kidney Transplantation Offers Prolonged Graft Survival

TL;DR

Dual kidney transplants from nonstandard donors offer better long-term kidney survival without worse short-term outcomes compared to single kidney transplants.

Contribution

Demonstrates that dual kidney transplantation improves medium-term graft survival and supports increased organ utilization from complex donor kidneys.

Findings

Dual kidney transplants had lower rates of acute rejection and graft failure compared to single kidney transplants.

There was no significant difference in perioperative outcomes like delayed graft function or hospital stay between the two procedures.

Dual kidney transplants did not increase the risk of death with a functioning graft.

Abstract

Dual kidney transplantation (DKT), an uncommonly performed procedure, provides a unique opportunity to transplant nonstandard kidneys that might otherwise not be utilized. We compared perioperative and five‐year posttransplant outcomes between DKT, and single kidney transplants (SKT) performed at our institution.

We analyzed all adult deceased donor kidney‐alone transplant recipients at our center between 2001 and 2020. Recipients of pediatric en bloc kidney transplants were excluded. Perioperative outcomes of interest included delayed graft function (DGF), posttransplant length of stay (LOS), rehospitalization, and reoperation. Five‐year outcomes included biopsy‐proven acute rejection (AR), death‐censored graft failure (DCGF), uncensored graft failure (UCGF), and death with functioning graft (DWFG).

A total of 100 DKT and 3125 SKT recipients were included. DKT recipients were older (p < 0.001), more often male (68%), and more often underwent early steroid withdrawal (p = 0.04). In comparison to SKT, after adjustment for multiple variables, DKT was not independently associated with DGF (aOR: 1.25; 95% CI 0.76–2.08); prolonged LOS (linear coefficient 0.42; −0.9–1.7); reoperation (aOR: 0.73; 95% CI: 0.21–2.51) or rehospitalization (aOR 0.98; 95% CI: 0.55–1.74). However, within five years, DKT had a lower adjusted incidence rate ratio (aIRR) for AR (aIRR: 0.28; CI 0.12–0.64); DCGF (aIRR: 0.30; 95% CI 0.13–0.68), and UCGF (aIRR: 0.53; 95% CI: 0.33–0.86), without statistically significant differences in DWFG (aIRR: 0.83; 95% CI: 0.46–1.53).

In selected recipients, DKT offered superior medium‐term outcomes compared to SKT without compromising perioperative outcomes. DKT can mitigate concerns associated with medically complex donor kidneys, increase organ utilization, and increase access to transplantation.

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