title: Dual kidney transplants from adult marginal donors successfully expand the limited deceased donor organ pool.
abstract: BACKGROUND
  The need to expand the organ donor pool remains a formidable challenge in kidney transplantation (KT). The use of expanded criteria donors (ECDs) represents one approach, but kidney discard rates are high because of concerns regarding overall quality. Dual KT (DKT) may reduce organ discard and optimize the use of kidneys from marginal donors.
  
  
  METHODS
  We conducted a single-center retrospective review of outcomes in adult recipients of DKTs from adult marginal deceased donors (DD) defined by limited renal functional capacity. If the calculated creatinine clearance in an adult DD was <65 mL/min, then the kidneys were transplanted as a DKT.
  
  
  RESULTS
  Over 11.5 yr, 72 DKTS were performed including 45 from ECDs, 17 from donation after cardiac death (DCD) donors, and 10 from standard criteria donors (SCD). Mean adult DD and recipient ages were both 60 yr, including 29 DDs and 26 recipients ≥65 yr of age. Mean pre-DKT waiting and dialysis vintage times were 12 months and 25 months, respectively. Actual patient and graft survival rates were 84.7% and 70.8%, respectively, with a mean follow-up of 58 months. One yr and death-censored graft survival rates were 90% and 80%, respectively. Outcomes did not differ by DD category, recipient age, or presence of delayed graft function (DGF). Eleven patients died at a mean of 32 months post-DKT (eight with functioning grafts) and 13 other patients experienced graft losses at a mean of 33 months. The incidence of DGF was 25%; there were two cases (2.8%) of primary non-function. Mean length of initial hospital stay was 7.2 d. Mean serum creatinine and glomerular filtration rate levels at 12 and 24 months were 1.5 and 53 and 1.5 mg/dL and 51 mL/min/1.73 m(2) , respectively. DKT graft survival and function were superior to concurrent single ECD and similar to concurrent SCD KTs. Two patients underwent successful kidney retransplantation, so the dialysis-free rate in surviving patients was 87%. The proportion of total renal function transplanted from adult DD to DKT recipients was 77% compared to 56% for patients receiving single KTs.
  
  
  CONCLUSIONS
  Dual kidney transplantation using kidneys from adult marginal DDs that otherwise might be discarded offer a viable option to counteract the growing shortage of acceptable single kidneys. Excellent medium-term outcomes can be achieved and waiting times can be reduced in a predominantly older recipient population.
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stratta
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Farney
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Orlando
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Umar
authors.initials: U
authors.lastname: Farooq
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Al-Shraideh
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Amudha
authors.initials: A
authors.lastname: Palanisamy
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Reeves-Daniel
authors.affiliation: Department of Pharmacy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: William
authors.initials: W
authors.lastname: Doares
authors.affiliation: Department of Pharmacy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Kaczmorski
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Gautreaux
authors.affiliation: Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Samy S
authors.initials: SS
authors.lastname: Iskandar
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Gloria
authors.initials: G
authors.lastname: Hairston
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Brim
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Mangus
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Hany
authors.initials: H
authors.lastname: El-Hennawy
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Khan
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rogers
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000379:methods*
keywords: acute kidney injury; delayed graft function; donation after cardiac death; dual kidney transplants; expanded criteria donors; kidney discard; marginal deceased donors; standard criteria donors