Outcomes of Dual Kidney Transplantation from Donors with High Pre-implantation Biopsy Scores.

In this real-world allocation cohort, kidneys with combined Karpinski score ≥9 achieved outcomes comparable to lower-score grafts when allocated as dual kidney transplantation.

These findings support the use of dual kidney transplantation as a strategy to safely expand the donor pool and suggest that high histological chronicity should not automatically preclude transplantation when integrated with clinical and functional donor assessment.