Single versus dual renal transplantation from donors with significant arteriosclerosis on pre-implant biopsy

Background: Transplantation of kidneys from donor with arteriosclerosis seen on pre-implantation biopsy has not been well studied.: We retrospectively evaluated 20 dual kidney transplant (DKT) and 28 single (SKT) kidney transplant recipients with ≥12 months follow-up from donors with moderate arteriosclerosis (≥25% luminal diameter narrowing). Methods: Death censored graft survival was 100% and 79%, respectively (p = 0.0339). DKT recipients had significantly lower mean creatinine levels at one, three, six, and nine months and spent somewhat less time on the waiting list (181 ± 160 vs. 318 ± 306d, p = 0.1429). DKT patients received kidneys from significantly older donors (64 ± 7 vs. 54 ± 11 yr; p = 0.0012), proportionately more expanded criteria donors (95% vs. 54%; p = 0.0029), and more donors with hypertension (81% vs. 48%, p = 0.0344) and death related to cerebrovascular accident (100% vs. 71%, p = 0.0143); however, more DKT kidneys underwent machine perfusion (95% vs. 575, p = 0.0068). Baseline recipient variables were comparable between the two groups including age, race, gender, retransplantation, and HLA mismatch. Pre-implant biopsy was notable for similar frequencies of moderate interstitial fibrosis (10% vs. 14%, respectively) and glomerulosclerosis. Conclusion: Among recipients of deceased-donor kidneys with >25% arteriosclerosis, short-term outcomes after DKT were superior to that of SKT grafts. This approach may help to expand the donor-organ pool while optimizing outcomes.