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Cohort studyAmerican journal of nephrology · 2026

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

Giorgia Comai, Michele Provenzano, Elisa Gessaroli … Valeria Corradetti

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NephrologyCohort study

Dual kidney transplantation can use grafts with Karpinski scores of 9 or higher.

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

Giorgia Comai et al. · American journal of nephrology · 2026

Background

The persistent shortage of transplantable kidneys has increased reliance on marginal organs, yet kidneys with advanced chronic lesions on pre-implantation biopsy are frequently discarded.

Methods

We conducted a retrospective cohort study of 262 adult deceased-donor kidney transplant recipients undergoing pre-implantation biopsy at a single Italian center between 2014 and 2021.

n = 262 adult

Results

a higher amount of damage in the kidney tissue before transplant

SKT <9

142

DKT <9

35

DKT ≥9

85

More results

DKT donors were older and had higher KDPI/KDRI than SKT donors.

Kaplan-Meier analyses showed no significant differences in overall graft failure, all-cause mortality, or death-censored graft failure.

In multivariable Cox regression, allocation group was not independently associated with overall graft failure.

“

Conclusion · 1 of 2

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

Conclusion · 2 of 2

These findings support the use of DKT 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.

Post

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

Dual kidney transplantation can use grafts with Karpinski scores of 9 or higher.

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