title: Middle and long-term outcomes of dual kidney transplant: a multicenter experience.
abstract: BACKGROUND
  Dual kidney transplantation (DKTx) to reduce the disparity between demand and supply of organs was evaluated in two Italian centers (Bari and Novara).
  
  
  METHODS
  Between October 2000 and October 2011, we performed 97 DKT (26 ipsilateral/71 bilateral) following routine biopsy of all kidneys obtained from expanded criteria donors by Remuzzi-Karpinsky scores. The reference group was 379 single grafts from donors older than 60 years single kidney transplantation ([SKT] × > 60).
  
  
  RESULTS
  Good postoperative renal function was observed in 56 DKTx (57.7%); whereas acute tubular necrosis requiring dialysis was observed in 41 (42.3%) patients. After a mean follow-up of 60 months, DKTx graft survivals were 96%, 93%, and 90% and patient survivals, 96%, 91%, and 91% at 1, 3, and 5 years, respectively. Complications in expanded criteria donor kidney transplantations included a high rate of cytomegalovirus (CMV) disease especially dual kidney cases. DKTx represented the only independent risk factor for CMV disease upon multivariate analysis (odds ratio [OR] 2.33, 95% confidence interval [CI] 1.28-4.2; P = .006). We did not observe any significant difference in graft or patient survival between DKTx and SKTx > 60 years.
  
  
  CONCLUSIONS
  We observed good outcomes up to 5 years after transplantation in terms of graft and patient survival despite the use of inferior grafts. Comparing DKTx and SKT > 60, we noted that the mean Karpinski score for SKTx was significantly better than DKTx, although patient and graft survivals were similar. This trend confirms that the use of a biopsy to allocate expanded criteria donor kidneys may be too protective; therefore, the criteria to select DKTx require further refinement.
authors.affiliation: Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. stefanovittorio@gmail.com
authors.forename: S V
authors.initials: SV
authors.lastname: Impedovo
authors.forename: E
authors.initials: E
authors.lastname: De Lorenzis
authors.forename: A
authors.initials: A
authors.lastname: Volpe
authors.forename: L
authors.initials: L
authors.lastname: Gesualdo
authors.forename: G
authors.initials: G
authors.lastname: Grandaliano
authors.forename: S
authors.initials: S
authors.lastname: Palazzo
authors.forename: G
authors.initials: G
authors.lastname: Lucarelli
authors.forename: C
authors.initials: C
authors.lastname: Bettocchi
authors.forename: C
authors.initials: C
authors.lastname: Terrone
authors.forename: P
authors.initials: P
authors.lastname: Stratta
authors.forename: M
authors.initials: M
authors.lastname: Quaglia
authors.forename: M
authors.initials: M
authors.lastname: Battaglia
authors.forename: P
authors.initials: P
authors.lastname: Ditonno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D016896:Treatment Outcome