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When the transplant physician considers that a single kidney from a given donor will not be sufficient to add sustained stable kidney function, dual KT has been proposed. The objective is to assess if dual kidney transplantation (KT) is better than single KT for optimizing the use of elderly kidneys.We did a systematic literature search and meta-analyses when possible, pooling data for calculating relative risks (RR) of major outcomes, comparing dual with single KT.Twenty-eight studies met the inclusion criteria. One-year serum creatinine was better after dual vs single KT (mean difference -0.27 [-0.37,-0.17], p<0.001), with less incidence of acute rejection in dual KT (RR 0.66 [0.52, 0.85], p<0.001) and without differences at five years. Less DGF was seen in dual vs single KT (RR 0.88 [0.76,1.02], p=0.09). Mortality at 1 and 3 years was similar after dual or single KT but mortality at five years was lower after dual vs single KT(RR 0.71 [0.54, 0.94], p=0.02). One-year graft loss was similar between dual (n=4158) and single KT (n=51800) (RR 0.99 [0.90, 1.08], p=0.82). Three and five-year graft loss was not considered because high heterogeneity between studies.Short-term graft function and long-term patient survival are better in recipients receiving dual KT vs single KT. However, these differences are based in few retrospective reports with a relatively low number of cases. Good quality randomized controlled trials are needed to assess if the investment of two kidneys in one recipient is justified in face of the current organ shortage.