Dual Kidney Transplantation

Dual kidney transplantation (DKT) is the placement of both kidney allografts from a “marginal” deceased donor (MDD) into the same recipient and has developed in response to the continuous organ shortage and increased attention on reducing rates of organ discard [1–3]. Kidneys from MDDs tend to have a lower creatinine clearance due to reduced functional nephron mass, leading to shorter projected allograft survival. Simultaneous transplant of such kidneys, otherwise not appropriate for a single transplant, thereby allows for the expansion of the cadaveric donor pool [4, 5]. This practice was first reported by the University of Maryland and Stanford University in the 1990s and is based on the concept of adequate nephron mass as a predictor of long-term graft outcome [6]. This chapter discusses recipient and donor criteria for consideration for DKT, surgical techniques, and outcomes after DKT. En-bloc transplantation of pediatric dual kidneys is not addressed as it constitutes a separate entity.