Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 25:2025:7744010.
doi: 10.1155/joot/7744010. eCollection 2025.

Single Versus Dual Kidney Transplants From Marginal Donors: Balancing Survival and Resource Utilization

Kaufman D M  1 , J D Perkins  1   2 , Bakthavatsalam R  1 , Leca N  2   3 , Sibulesky L  1   2
Affiliations

Single Versus Dual Kidney Transplants From Marginal Donors: Balancing Survival and Resource Utilization

Kaufman D M et al. J Transplant. .

Abstract

Background: With population aging and increasing prevalence of kidney disease, a greater number of older patients could benefit from a kidney transplant. Organ shortage has led to expanding the pool of potential donors, including both kidneys from the same donor as dual transplants into a single recipient. At present, there is no consistent criteria for determining suitability for single versus dual transplant.

Methods: We performed a retrospective analysis of the Organ Procurement and Transplantation Network database of all recipients undergoing single or dual kidney transplants from deceased donors from December 4, 2014, to March 31, 2024, excluding en bloc donors. We examined patient and graft survival rates and graft function in dual versus single kidney transplantation. In addition, we analyzed potential survival differences between using a single kidney transplantation over dual transplantation.

Results: During the study period, there were a total of 1015 dual kidney transplant recipients and 134,933 single kidney recipients. The donors of the dual transplants were older, had higher KDRI, and had increased rates of glomerulosclerosis, with > 20% glomerulosclerosis seen in 20% of the kidneys. Using 3:1 propensity matching, we did not observe a significant difference in overall patient survival. We did observe a significant increase in graft survival with dual transplants. Transplanting all dual kidneys as single kidneys could result in a 0.9% increase in overall successful transplants and a 3% reduction in waitlist deaths.

Conclusion: Careful donor and recipient matching are crucial to optimize outcomes in this population. More emphasis needs to be placed on maximizing survival benefit from each donor kidney.

Keywords: dual kidney transplant; kidney graft survival; kidney transplant patient survival; single kidney transplant.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
A microsimulation analysis of evaluating the impact of increasing the transplant probabilities by transplanting all dual kidneys as single transplants.
Figure 2
Figure 2
Patient survival between dual and single kidney transplantation.
Figure 3
Figure 3
Overall graft survival of dual versus single kidney transplants.
Figure 4
Figure 4
Death-censored graft survival of dual versus single kidney transplants.
See this image and copyright information in PMC

References

    1. Mallappallil M., Friedman E. A., Delano B. G., McFarlane S. I., Salifu M. O. Chronic Kidney Disease in the Elderly: Evaluation and Management. Clinical Practice . 2014;11(5):525–535. doi: 10.2217/cpr.14.46. - DOI - PMC - PubMed
    1. Kaballo M. A., Canney M., O’Kelly P., Williams Y., O’Seaghdha C. M., Conlon P. J. A Comparative Analysis of Survival of Patients on Dialysis and After Kidney Transplantation. Clinical Kidney Journal . 2018;11(3):389–393. doi: 10.1093/ckj/sfx117. - DOI - PMC - PubMed
    1. Arcos E., Pérez-Sáez M. J., Comas J., Lloveras J., Tort J., Pascual J. Assessing the Limits in Kidney Transplantation: Use of Extremely Elderly Donors and Outcomes in Elderly Recipients. Transplantation . 2020;104(1):176–183. doi: 10.1097/tp.0000000000002748. - DOI - PubMed
    1. Rao P. S., Merion R. M., Ashby V. B., Port F. K., Wolfe R. A., Kayler L. K. Renal Transplantation in Elderly Patients Older than 70 Years of Age: Results From the Scientific Registry of Transplant Recipients. Transplantation . 2007;83(8):1069–1074. doi: 10.1097/01.tp.0000259621.56861.31. - DOI - PubMed
    1. Haller M. C., Kainz A., Baer H., Oberbauer R. Dialysis Vintage and Outcomes After Kidney Transplantation: A Retrospective Cohort Study. Clinical Journal of the American Society of Nephrology . 2017;12(1):122–130. doi: 10.2215/cjn.04120416. - DOI - PMC - PubMed

LinkOut - more resources