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Background <p>The transplantation of a single kidney, while its partner kidney is discarded despite both having been initially offered (dual-offered, single-transplanted; DOST), represents a missed opportunity to preserve nephron mass and optimize donor utilization. Dual kidney transplantation (DKT) preserves nephron mass by transplanting both kidneys from a higher-risk donor, but its benefits relative to DOST remain underexplored.</p> Methods <p>In this nationwide multicenter cohort (2008–2021), we analyzed 36 DKT and 20 DOST recipients. Both groups were propensity-matched 1:2 to 112 regular single-kidney transplant recipients (RegT) based on donor and recipient characteristics. The primary endpoint was estimated glomerular filtration rate (eGFR) at 12 months. Secondary endpoints included eGFR through 5 years, death-censored graft and patient survival, perioperative metrics, and 12-month quality of life (EQ-5D).</p> Results <p>At 12 months, median eGFR was higher in DKT (50.8 ml/min/1.73 m<sup>2</sup>) than DOST (33.5 ml/min/1.73 m<sup>2</sup>) or RegT (38.0 ml/min/1.73 m<sup>2</sup>; <i>p</i> &lt; 0.001), with differences sustained through 5 years. Graft and patient survival were similar. DKT involved longer surgery (270 vs. 163 min; <i>p</i> &lt; 0.001), greater blood loss (550 vs. 300 ml; <i>p</i> = 0.084), and more transfusions (75% vs. 30%; <i>p</i> = 0.0017) but no increase in delayed graft function or major complications. EQ-5D scores were higher in DKT (85.0) than DOST (70.0) and RegT (71.0; <i>p</i> = 0.048).</p> Conclusion <p>DKT is an effective approach for higher-risk donor kidneys and was associated with higher graft function and quality of life. Despite increased operative complexity and transfusion requirements, there was no evidence of increased postoperative morbidity. Broader adoption may reduce unnecessary kidney discards and improve transplant outcomes, although findings should be interpreted in light of the limited sample size and observational design.</p>

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Single-kidney transplantation with discarded partner kidney vs. Dual kidney transplantation: results from a national cohort study

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  • 发表日期：

    2026年4月10日

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  • Stephanie Näf,
  • Simon Schwab,
  • Isabelle Binet,
  • Alexander Ritter,
  • Max J. Rieger,
  • Déla Golshayan,
  • Fadi Haidar,
  • Franz Immer,
  • Thomas Schachtner,
  • Stefan Schaub,
  • Thomas Wolff,
  • Rafal Porzucek,
  • Daniel Sidler,
  • Christian Kuhn,
  • Patrizia Amico,
  • Adrian Bachofner,
  • Vanessa Banz,
  • Sonja Beckmann,
  • Guido Beldi,
  • Christoph Berger,
  • Ekaterine Berishvili,
  • Annalisa Berzigotti,
  • Pierre-Yves Bochud,
  • Petra Borner,
  • Sanda Branca,
  • Anne Cairoli,
  • Emmanuelle Catana,
  • Yves Chalandon,
  • Philippe Compagnon,
  • Sabina De Geest,
  • Sophie De Seigneux,
  • Michael Dickenmann,
  • Joëlle Lynn Dreifuss,
  • Thomas Fehr,
  • Sylvie Ferrari-Lacraz,
  • Andreas Flammer,
  • Jaromil Frossard,
  • Nicolas Goossens,
  • Jörg Halter,
  • Christoph Hess,
  • Sven Hillinger,
  • Hans Hirsch,
  • Patricia Hirt,
  • Linard Hoessly,
  • Uyen Huynh-Do,
  • Nina Khanna,
  • Michael Koller,
  • Angela Koutsokera,
  • Andreas E. Kremer,
  • Thorsten Krueger,
  • Arnaud L’Huillier,
  • Bettina Laesser,
  • Frédéric Lamoth,
  • Roger Lehmann,
  • Alexander Leichtle,
  • Oriol Manuel,
  • Hans-Peter Marti,
  • Michele Martinelli,
  • Valérie McLin,
  • Katell Mellac,
  • Aurélia Merçay,
  • Karin Mettler,
  • Sara Christina Meyer,
  • Zou Ming,
  • Nicolas Müller,
  • Jelena Müller,
  • Ulrike Müller-Arndt,
  • Mirjam Nägeli,
  • Dionysios Neofytos,
  • Jakob Nilsson,
  • Manuel Pascual,
  • Rosmarie Pazeller,
  • David Reineke,
  • Juliane Rick,
  • Fabian Rössler,
  • Silvia Rothlin,
  • Dominik Schneidawind,
  • Macé Schuurmans,
  • Thierry Sengstag,
  • Federico Simonetta,
  • Jürg Steiger,
  • Guido Stirnimann,
  • Christian Van Delden,
  • Jean-Pierre Venetz,
  • Jean Villard,
  • Julien Vionnet,
  • Laura Walti,
  • Caroline Wehmeier,
  • Patrick Yerly

摘要

Background

The transplantation of a single kidney, while its partner kidney is discarded despite both having been initially offered (dual-offered, single-transplanted; DOST), represents a missed opportunity to preserve nephron mass and optimize donor utilization. Dual kidney transplantation (DKT) preserves nephron mass by transplanting both kidneys from a higher-risk donor, but its benefits relative to DOST remain underexplored.

Methods

In this nationwide multicenter cohort (2008–2021), we analyzed 36 DKT and 20 DOST recipients. Both groups were propensity-matched 1:2 to 112 regular single-kidney transplant recipients (RegT) based on donor and recipient characteristics. The primary endpoint was estimated glomerular filtration rate (eGFR) at 12 months. Secondary endpoints included eGFR through 5 years, death-censored graft and patient survival, perioperative metrics, and 12-month quality of life (EQ-5D).

Results

At 12 months, median eGFR was higher in DKT (50.8 ml/min/1.73 m2) than DOST (33.5 ml/min/1.73 m2) or RegT (38.0 ml/min/1.73 m2; p < 0.001), with differences sustained through 5 years. Graft and patient survival were similar. DKT involved longer surgery (270 vs. 163 min; p < 0.001), greater blood loss (550 vs. 300 ml; p = 0.084), and more transfusions (75% vs. 30%; p = 0.0017) but no increase in delayed graft function or major complications. EQ-5D scores were higher in DKT (85.0) than DOST (70.0) and RegT (71.0; p = 0.048).

Conclusion

DKT is an effective approach for higher-risk donor kidneys and was associated with higher graft function and quality of life. Despite increased operative complexity and transfusion requirements, there was no evidence of increased postoperative morbidity. Broader adoption may reduce unnecessary kidney discards and improve transplant outcomes, although findings should be interpreted in light of the limited sample size and observational design.