Background. Because of the problem of organ shortage, the use of renal tran
splants from marginal donors has been tested by different procedures.
Methods. In our center 26 recipients (59+/-7 years) underwent double renal
transplantation from July 1996 to August 1999 using marginal donors (71+/-6
years). A special scoring was applied that included donor age, serum creat
inine, the grade of glomerulosclerosis, and kidney weights leading to the d
ecision whether single or dual or no kidney transplantation was performed.
Results. After an average follow-up of 18+/-10 months 22 of 26 (85%) double
kidney transplant recipients are alive and have functioning grafts. Three
patients died with well-functioning grafts. The actuarial 1-year patient an
d graft survival rate was 94% (n=18), the 8-year rate 92% (n=12). Two patie
nts lost one graft each without becoming dialysis dependent. The average se
rum creatinine was 1.6+/-0.5 mg/dl after 12 months (n=17) and 1.9+/-0.6 mg/
dl after 24 months (n=11). Primary nonfunction occurred in 31%, acute rejec
tion within the first 6 months in 14%. Ten patients who received single old
grafts according to our score had similar transplant survival rates but wo
rse graft function after 1 year.
Conclusions. Transplant function and survival of patients after dual kidney
transplantation indicate that this procedure is reasonable to ameliorate t
he problem of organ shortage. The most crucial point is to establish a wide
ly accepted standardized scoring for the donors leading to single, dual, or
refusal of transplantation.