Book chapter
Strategies for the successful transplantation of dual adult marginal donor kidneys
Cutting Edge Advances in Transplantation, pp 55-93
01 Jan 2026
Abstract
The practice of dual kidney transplantation (DKT) from adult marginal deceased donors (MDDs) dates back to the mid-1990s, with initial pioneering experiences reported by the Stanford and Maryland groups, at which time the primary indication for DKT was estimated to be insufficient nephron mass from older donors. Although initial studies reported a sequential bilateral technique of DKT, prior experience with transplantation of pediatric en bloc (EB) kidneys and horseshoe kidneys paved the way for the application of ipsilateral and EB procedures in adult DKT. Multiple subsequent studies of short and long-term outcomes have been reported, focusing on three major aspects of DKT: Identifying appropriate donor selection criteria and developing scoring systems based on pre- and postdonation factors; refining technical aspects of the transplant procedure; and analyzing longer-term outcomes. The number of adult DKTs performed in the United States has declined in the past decade, and at present<60 are performed annually. For adult deceased donor kidneys meeting double allocation criteria,>60% are ultimately not transplanted. Deceased donors with limited renal functional capacity represent a large proportion of potential kidneys doomed to either discard or nonrecovery. However, DKT may reduce organ discard and optimize the use of kidneys from MDDs. In an attempt to promote utilization of MDD kidneys, the United Network for Organ Sharing introduced new allocation guidelines pursuant to DKT in 2019. The purpose of this review is to chronicle the history of DKT with specific attention to surgical techniques and then identify opportunities to improve utilization of MDD kidneys through DKT.
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Details
- Title
- Strategies for the successful transplantation of dual adult marginal donor kidneys
- Creators
- Robert J Stratta - Wake Forest UniversityDai Dao Nghiem - Drexel University, College of Medicine
- Contributors
- Dai Dao Nghiem (Editor) - Allegheny General Hospital
- Publication Details
- Cutting Edge Advances in Transplantation, pp 55-93
- Publisher
- Elsevier
- Edition
- 1st
- Number of pages
- 39
- Resource Type
- Book chapter
- Language
- English
- Academic Unit
- College of Medicine
- Scopus ID
- 2-s2.0-105036939588
- Other Identifier
- 991022184876104721