Dual versus Single Kidney Transplantation in Contemporary U.S. Practice: A National Matched Cohort Study.

BACKGROUND: Hard-to-place kidneys remain underutilized despite ongoing organ shortage. Dual kidney transplantation (DKT) may improve use of these grafts, but contemporary national data are limited. METHODS: We performed a retrospective cohort study using national databases from March 2015 to December 2024. Outcomes after DKT and single kidney transplantation (SKT) were compared in the overall cohort and after 2:1 propensity score matching (PSM) using Kaplan-Meier, Cox, and logistic regression. RESULTS: A total of 140,707 deceased donor kidney transplants were analyzed, including 1,236 (0.9%) DKT. In the overall cohort, DKT was associated with lower graft and patient survival. After 2:1 PSM, 1,105 DKT recipients were matched to 2,210 SKT recipients with balanced recipient age (63.7 vs 63.9 years) and KDPI (75.5 vs 75.8; SMD <0.03). After PSM, DKT was associated with higher 1-, 3-, and 5-year graft survival (92.2%, 81.8%, and 69.8% vs 87.7%, 75.5%, and 59.9%; all P < 0.001), while DGF rates were similar. CONCLUSION: DKT remains an uncommon but important strategy for utilization of hard-to-place donor kidneys. After matching recipients with comparable age and KDPI, DKT was associated with favorable graft and patient survival and similar DGF rates, supporting selective use in carefully chosen recipients.