Outcomes of dual kidney transplants from high KDPI kidneys are superior compared to single kidney high KDPI transplants at 1 year

Dual kidney transplantation (DKT), utilizing two adult kidneys from the same donor for one recipient, has been used as a way to expand the available donor pool. These kidneys often come from high Kidney Donor Profile Index donors (KDPI > 85%). Data comparing outcomes between high KDPI DKT and single kidney transplants (SKT) remain limited. We assessed outcomes of 336 high KDPI kidney transplants performed at our center; 11.0% (n = 37) were DKT. Recipients of DKT were older (P =.02) and donors had a higher KDPI score (median 96% vs. 91%, P <.0001). DKT operative time was higher compared to SKT (+1.4 hours, P <.0001). There were no differences in delayed graft function (54.1% vs. 51.5%, P =.77) and hospital length of stay (median 4.0 vs. 3.0 days, P =.21) between DKT and SKT. Grade I Clavien-Dindo complications occurred in 8.1% of DKT and 13.7% of SKT (P =.008). There were no grade IVa, IVb, or V complications in either group. DKT had more glomerulosclerosis (P =.04), interstitial fibrosis (P =.02), tubular atrophy (P =.01), and arterial thickening (P =.03) on 1-year protocol biopsies. Estimated glomerular filtration was higher for DKT at 1- (P =.004) and 2-years post-transplant (P =.01). There were no differences in patient (HR 1.3, 95% CI.5-3.3, P =.58) or graft (HR 1.1, 95% CI.5-2.3, P =.83) survival. Good outcomes can be achieved with DKT using high KDPI kidneys with moderate chronic changes. DKT is a good option to help further utilize high KDPI kidneys and minimize discard.