Double kidney transplantation.

The incidence of end-stage renal failure has been increasing for many years with a marked elevation of the mean age of kidney transplantation candidates. This situation contrasts with the shortage of kidney transplants. One solution, apart from the development of live donor kidney transplantation, is the use of so-called "borderline" cadavre kidneys. Double kidney transplantation is performed in the context of enlargement of the number of "borderline" donors. A review of the medical literature reporting the experience acquired in double kidney transplantation demonstrates a marked heterogeneity of donor selection criteria between the various teams. Recipients are generally selected from among the oldest patients waiting for transplantation. Double kidney transplantation is not associated with any excess mortality and graft survival and graft function are perfectly satisfactory, ensuring a serum creatinine close to 200 mu mol/l at 3 years. These results are obtained at the price of low morbidity. Wound complications are not more frequent than after single kidney transplantation. With the exception of one team, vascular complications are not more frequent, but are even more serious than for single kidney transplantation. Ureteric strictures and fistulas are observed more frequently when the two ureters are reimplanted into a common conduit in the case of homolateral transplantation of the two kidneys. Overall, double kidney transplantation has allowed a 10% increase in the recruitment of "borderline" kidneys by all teams with satisfactory functional results and low morbidity. However, donor and recipient selection criteria for double kidney transplantation need to be more precisely defined to avoid depriving elderly patients of transplantation and to avoid using two kidneys in the same recipient when one kidney would have ensured a satisfactory functional result. Two ongoing French studies will probably allow progress in this direction by evaluating the feasibility and benefits of this technique in France.