Non-Inferiority of Dual Kidney Transplantation: A Retrospective Matched Study

Background/Objectives: Dual kidney transplantation is a potential technique to reduce the number of discarded kidneys from expanded-criteria donors. Due to allegedly poor outcomes, some centres have abandoned this technique. We aimed to compare dual versus single kidney transplantation. Methods: This retrospective, propensity score-matched, non-inferiority study compared dual kidney transplantation and single kidney transplantation results. Matching was performed based on key donor characteristics, including age, sex, serum creatinine levels, and cause of death due to cerebrovascular accident. The primary outcome was graft survival at ten years post-transplant. Secondary outcomes included overall survival and perioperative complications. Non-inferiority of dual kidney transplantation was defined as a difference in graft survival within a 10% margin. Results: After propensity score, 39 dual kidney transplant recipients were matched with 78 single kidney transplants. Five-year graft survival was 66.1% for dual kidney transplants and 81.3% for single kidney transplants (p = 0.228), and 9-year graft survival was 54.1% dual transplant and 60.8% for single transplant (p = 0.961). There was no significant difference in terms of 10-year overall survival (p = 0.912) either. Surgical times were greater during dual kidney transplants (199.31 ± 49.12 min vs. 129.37 ± 42.11 min, p < 0.001). There were more overall complications associated with dual kidney transplants (35.9% vs. 17.9%, p < 0.05). Conclusions: Dual kidney transplantation achieved non-inferiority for ten-year graft and overall survival, despite higher incidence of complications and longer surgical times. Dual kidney transplantation can be a viable alternative to single kidney transplantation and may increase the pool of potential donors, reducing renal transplant waiting lists.