title: Strategies for compensating for the declining numbers of cadaver donor kidney transplants.
abstract: BACKGROUND
  The living-donor and dual kidney transplantation programmes were initiated in the transplantation centre of Münster (TCM) as two approaches to compensate for the declining numbers of cadaver donor kidney transplants after the implementation of the new Eurotransplant Kidney Allocation System (ETKAS). We analysed the outcome of cadaver, living-donor and dual kidney transplantation and their effects on the waiting list in the TCM.
  
  
  METHODS
  Between January 1990 and December 2000, 1184 kidney transplants were performed in the TCM. They were subdivided into cadaver, living-donor and dual kidney transplants and retrospectively analysed in terms of the number of kidney transplants performed, waiting time and waiting coefficient. In addition four representative groups were formed to reflect donor origin (I: cadaver kidney transplants allocated by the old ETKAS, n = 180; II: cadaver kidney transplants allocated by the new ETKAS, n = 139; III: living-donor kidney transplantation, n = 59; IV: dual kidney transplantation, n = 31) and compared according to graft function (initial diuresis, creatinine, 3-year graft function), patient survival and median waiting time.
  
  
  RESULTS
  After the implementation of the new ETKAS, the number of cadaver donor kidney transplants at the TCM almost halved, but the proportion of living-donor kidney transplantations increased significantly by 12.8% and of dual kidney transplantations by 8.5%. Patients who had received kidneys from cadaver donors allocated by the new ETKAS (group II) had a better survival rate, short- and long-term function but a longer waiting time than in group I (old ETKAS). Patients with dual kidney transplants (group IV) showed the lowest survival and short-term function rate, but had long-term function equivalent to that of cadaver kidney transplants (groups I and II). Patients who had received kidneys from living donors (group III) had the best survival, and short- and long-term function rate as well as the shortest mean waiting time.
  
  
  CONCLUSIONS
  Living-donor and dual kidney transplantation proved to be functionally equivalent alternatives and successful strategies for compensating the declining numbers of cadaver donor kidney transplants.
authors.affiliation: Surgical Research, Department of General Surgery, Münster University Hospital, Waldeyerstrasse 1, D-48149 Münster, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Palmes
authors.forename: Heiner Hubert
authors.initials: HH
authors.lastname: Wolters
authors.forename: Jens
authors.initials: J
authors.lastname: Brockmann
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.forename: Hans-Ullrich
authors.initials: HU
authors.lastname: Spiegel
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Dietl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D002648:Child; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D019520:Living Donors / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D014850:Waiting Lists