Background: Obesity among kidney transplant (KT) recipients can lead to metabolic comorbidity-associated deaths. This study compares post-KT survival between obese and non-obese patients and outcomes of living donor (LD) and deceased donor (DD) grafts. Methods: Between January 2005–May 2019, 1403 KT recipients from a single center were included in the study, as well as 314 patients (22.4%) with obesity (BMI > 30 kg/m²), 137 DD transplants, and 177 LD transplants. Of the 1089 (77.6%) in the control group (BMI ≤ 30 kg/m²), 384 were DD transplants and 705 LD transplants. The Kaplan–Meier method was used for survival analysis and a Cox regression was used to identify risk factors for graft loss and mortality. Propensity score matching analysis adjusting for age, IHD, and T2DM was performed. Results: The study group had higher incidence of obesity related comorbidities, delayed graft function and primary non function (p < 0.001). One-, 5-and 10-year patient and graft survival were lower in the study group (p < 0.001). Subgroup analysis of graft survival according to type of graft shows a difference in the DD (p = 0.002) but not in the LD group (p = 0.220). However, mortality was higher in both groups (LD, p = 0.045; DD, p = 0.004). Risk factors for mortality were age, T2DM, IHD, and DD, and for graft failure: IHD, BMI, donor age, re-transplant, and DD. Propensity score analysis shows an odds ratio of 0.81 for graft failure and 0.93 for death in the study group (95% CI = 0.55, 1.21, p = 0.3 and CI = 0.59, 1.46, p = 0.7, respectively). Conclusions: Recipient age and metabolic comorbidities should be emphasized when evaluating patients with obesity. We suggest considering weight loss interventions using the new GLP-1 inhibitors and bariatric procedures in selected patients to prepare overweight patients for transplant.

Background/Objectives: Double ureter kidney grafts raise concerns about increased urologic complications. Limited data exist on optimal surgical management due to small sample sizes in previous reports. This study evaluated outcomes using pantaloon ureteroneocystostomy in the largest reported cohort worldwide. Research Questions: Does pantaloon ureteroneocystostomy achieve comparable outcomes to single ureter transplants? Are long-term graft survival and function equivalent? Should this technique be adopted as standard practice? Methods: This retrospective matched cohort study involves 2210 kidney transplantations (2010–2024). Twenty-six double ureter grafts underwent pantaloon ureteroneocystostomy with dual stenting. Controls matched 1:1 for donor type, era, and recipient characteristics. The primary outcome was urologic complications. Statistical analysis included Kaplan–Meier survival curves and Mann–Whitney U tests. Results: Groups were well matched (median age: 51 vs. 52 years, 50% living donors each). Urologic complications occurred in 3.8% double ureter versus 7.7% control grafts (p = 1.000), markedly lower than 15.4% reported in recent literature. The single complication was early urinary leak, surgically repaired. No late strictures developed. The 5-year graft survival was 96.0% vs. 92.3% (p = 1.000). The final creatinine was comparable (1.25 vs. 1.28 mg/dL, p = 0.891). Conclusions: The pantaloon technique achieves superior outcomes in the largest reported double ureter cohort, with complication rates lower than previously published series. These findings support adopting this standardized approach globally to expand donor criteria while maintaining excellent outcomes.

Background: Uncontrolled donation after circulatory death (uDCD) remains underutilized globally, despite critical organ shortages. We report outcomes from Israel’s uDCD kidney transplant program compared with the matched donation after brain death (DBD) recipients. Methods: This retrospective cohort study analyzed all uDCD kidney transplants performed at the Rabin Medical Center between January 2018 and December 2024, compared with DBD transplants during the same period. Propensity score matching (1:3 ratio) was performed using recipient demographics, comorbidities, and donor characteristics. Primary outcomes included delayed graft function (DGF), graft failure, and patient survival. Results: Among 92 kidney transplants, 21 (22.8%) were from uDCD donors. After propensity-matching (21 uDCD, 63 DBD), significant baseline differences persisted: uDCD recipients were younger (47.2 ± 11.8 vs. 57.5 ± 10.9 years, p < 0.001) despite a similar dialysis vintage (7.2 ± 3.2 vs. 7.7 ± 3.7 years, p = 0.569). Warm ischemia time was 58.5 ± 12.3 vs. 3.0 ± 0.0 min (p < 0.001), and cold ischemia time was longer in uDCD (13.7 ± 5.9 vs. 8.4 ± 2.5 h, p < 0.001). DGF occurred in 90.5% of uDCD versus 54.1% of DBD recipients (p = 0.006). Graft failure was markedly higher in uDCD (28.6% vs. 1.6%, p = 0.001), yet mortality was lower (14.3% vs. 27.9%, p = 0.339). After a median follow-up of 60 months (IQR 48–72) for both groups, the death-censored 5 year graft survival rate was 71.4% for uDCD versus 98.4% for DBD (p < 0.001). Conclusions: Despite higher rates of DGF and graft failure, uDCD kidney transplantation demonstrated an acceptable 5 year patient survival rate in carefully selected younger recipients. These findings support cautious expansion of uDCD programs with rigorous recipient selection criteria and realistic outcome expectations.