A Modified Approach to Dual Kidney Transplantation.

We present a modified dual kidney transplantation technique using a cold-preserved third-party donor iliac conduit fashioned into a Y-shaped graft, addressing the limitations of conventional approaches. Both kidneys were preserved with hypothermic machine perfusion and implanted unilaterally in the right iliac fossa. A cold-preserved third-party donor iliac artery was fashioned into a Y-shaped interposition graft, enabling a single arterial anastomosis to the internal iliac artery; both renal veins were anastomosed to the external iliac vein. Each ureter was implanted separately into the bladder. The warm ischemia time was 5 minutes, the cold ischemia time 14 hours, and the operative duration 186 minutes. The patient demonstrated immediate graft function without dialysis. The serum creatinine decreased to 153 µmol/L at discharge and stabilized around 210 µmol/L at follow-up. Color Doppler examination and magnetic resonance angiography confirmed good graft perfusion without stenosis, kinking, or thrombosis. This technique combines the efficiency of a single arterial anastomosis with the preservation of operative workspace, avoids dependence on quality of the index donor's iliac artery, and enables the reliable placement of both grafts in the right iliac fossa, providing a promising option for expanded-criteria donor utilization.