A single-center experience with 200 dual kidney transplantations Rigotti P, Capovilla G, Di Bella C, Silvestre C, Donato P, Baldan N, Furian L. A Single-center experience with 200 dual kidney transplantations. Abstract: This study reports on a large series of 200 dual kidney transplantations (DKTs) from expanded criteria donors (ECDs) and proposes specific ways to optimize outcomes. Data concerning 200 DKTs performed in the last 14 yr were retrospectively analyzed. Kidneys from high-risk ECD were allocated for use in DKTs on an old-for-old basis after histological assessment. Different surgical techniques and immunosuppressant regimens were used over time, and the outcomes are discussed. Donors and recipients were a median 73 (70–77) and a 62 (58–67) yr old, respectively. Delayed graft function occurred in 31.5% of cases, and acute rejection in 13.5%. Patient and graft survival at five yr were 90.4% and 85.8%, respectively. Unilateral kidney placement was preferred for 75% of patients, and was associated with a low rate of surgical complications. Our current standard therapy comprising low- dose calcineurin inhibitors (CNIs) associated with mammalian target of rapamycin inhibitors (mTOR) and steroids appears to offer the best risk/ benefit profile for elderly patients undergoing DKT. In our experience, outcomes after DKT can be improved by: (i) kidney clinical–histological assessment; (ii) unilateral kidney placement; (iii) minimal use of CNI associated with mTOR. Paolo Rigotti, Giovanni Capovilla, Caterina Di Bella, Cristina Silvestre, Paola Donato, Nicola Baldan and Lucrezia Furian Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, Padua University Hospital, University of Padua, Padua, Italy Key words: donor selection – dual kidney transplantation – immunosuppressant therapy – surgical technique Corresponding author: Paolo Rigotti, MD, SSD Trapianti Rene-Pancreas, Via Giustiniani 2, 35128 Padova (PD), Italy. Tel: +393404990598; fax: +390498213152; e-mail: paolo.rigotti@unipd.it Conflict of interest: The authors have no conflicts of interest to disclose. Accepted for publication 3 October 2014 Dual kidney transplantation (DKT) is a surgical procedure that consists of placing two kidneys in a single recipient. The technique has attracted increasing interest because it enables the use of suboptimal kidneys procured from expanded cri- teria donors (ECD). The percentage of >60-yr- old donors used in the area served by the North Italy Transplant program (NITp) has risen stea- dily in recent years. The same trend has been seen in other European countries too: after a threefold increase between the periods 1990–1999 and 2000–2010, these donors now account for more than half the donor pool (1). Elderly donors represent the most important category among ECDs in our clinical practice. They are associated with a risk of poor long-term out- come due to an age-related reduction in nephron mass that can ultimately result in higher rates of primary nonfunction (PNF), delayed graft func- tion (DGF), and shorter graft survival (2, 3). In this scenario, DKT appears to be a good way to provide recipients with an adequate number of functioning nephrons. In a prospective, multicen- ter, case–control study, Remuzzi et al. (4) dem- onstrated that DKT achieved a better renal function and blood pressure control, with no added risk of surgical complications compared with recipients of single ideal kidneys. The pro- cedure raises additional allocation issues, how- ever, relating to the potential misuse of two grafts for only one recipient, and the surgical technique is more complex. Immunosuppressant therapies also need to be tailored to DKT recipi- ents, who are more exposed to nephrotoxicity. On the whole, although DKT has gained accep- tance since it was first described in 1996 (5), the debate is still open on the standardization of donor selection criteria, surgical techniques, and immunosuppressant regimens for this popula- tion. The present report describes our 14-yr experi- ence with what we believe is the largest single- center series of DKTs to be published to date. Our aim is to describe how the selection criteria and 1433 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Clin Transplant 2014: 28: 1433–1440 DOI: 10.1111/ctr.12475 Clinical Transplantation