Long-term survival benefit from dual kidney transplantation using kidneys from donors with very extended criteria - A French cohort between 2002 and 2014.

Background This national multicenter retrospective cohort study aimed to assess the long-term outcomes of dual kidney transplantation (DKT) and compare them with those obtained from single kidney transplantation (SKT). Methods Our first analysis concerned all first transplants performed between May 2002 and December 2014, from marginal donors, defined as brain death donors older than 65, with an estimated glomerular filtration rate (eGFR) lower than 90 ml/min/1.73m². The second analysis was restricted to transplants adequately allocated according to the French DKT program based on donor eGFR: DKT for eGFR between 30 and 60, SKT for eGFR between 60 and 90 ml/min/1.73m². Recipients younger than 65 years or with a panel-reactive antibody percentage ≥ 25% were excluded. Results The first analysis included 461 DKT and 1131 SKT. DKT donors were significantly older (77.6 versus 74 years), had a more frequent history of hypertension and a lower eGFR (55.1 versus 63.6 ml/min/1.73m²). While primary nonfunction and delayed graft function did not differ between SKT and DKT, 1-year eGFR was lower in SKT recipients (39 vs. 49 ml/min/1.73m², P Conclusions In a context of organ shortage, DKT is a good option for optimizing the use of kidneys from very expanded criteria donors.