title: Dual-kidney transplantation with organs from expanded criteria donors: a long-term follow-up.
abstract: BACKGROUND
  Since 1995, dual-kidney transplantation using organs from marginal donors has been used at our center to expand the organ donor pool and decrease the waiting time for deceased donor kidney transplantation. This approach has allowed for a shorter waiting period without compromising outcome in the early posttransplant period. We now have 8-year follow-up in the first recipients. Older individuals were offered this option preferentially, because we reasoned that they would stand to benefit most from the shorter waiting period.
  
  
  METHODS
  Patients aged 55 years or more who underwent either dual-kidney transplantation with expanded criteria donors or single-kidney transplantation with standard donors were included in this study. All expanded criteria donor organs were those that were refused by all other local transplant centers. The primary endpoints were recipient death and graft failure.
  
  
  RESULTS
  Waiting time for dual-kidney transplantation was 440 +/- 38 days versus 664 +/- 51 days for single-kidney transplantation (P<0.01). The 8-year actuarial patient survivals for the single- and dual-kidney transplants were 74.1% and 82.1%, respectively. The 8-year actuarial graft survivals for the single- and dual-kidney transplants were 59.4% and 69.7%, respectively.
  
  
  CONCLUSIONS
  Eight-year actuarial patient and graft survivals in older individuals who underwent dual-kidney transplantation are equivalent to those who underwent standard single-kidney transplantation. With the continuing organ shortage and increasing waiting times for cadaver kidney transplantation, dual-kidney transplantation using organs that would otherwise be discarded offers a good option for older individuals who may not withstand a long waiting period.
authors.affiliation: Kidney and Pancreas Transplant Program, Stanford University Medical Center, 750 Welch Road, Palo Alto, CA 94304-1509, USA. jane.tan@stanford.edu
authors.forename: Jane C
authors.initials: JC
authors.lastname: Tan
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Alfrey
authors.forename: Donald C
authors.initials: DC
authors.lastname: Dafoe
authors.forename: Maria T
authors.initials: MT
authors.lastname: Millan
authors.forename: John D
authors.initials: JD
authors.lastname: Scandling
mesh_terms: D000206:Actuarial Analysis; D002102:Cadaver; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine