title: Optimization of expanded donors using dual kidney transplantation: case-control study.
abstract: BACKGROUND
  Cadaveric donation is now experiencing a trend toward the use of expanded criteria donors (ECD) who may not yield a suitable kidney for single organ transplantation which has occasionally led to their use as dual renal transplantations.
  
  
  METHODS
  We undertook a case-control study to analyze our experiences between May 2007 and March 2011 with 80 kidneys from ECD who were older than 65 years. Of these, 40 were used as single transplants (STX) and the other 40 as dual cases (DTX). Criteria to determine STX versus DTX were established by biopsy results and other donor factors.
  
  
  RESULTS
  The mean age of the ECD for STX was 68.7 ± 3.0 years and for DTX, 74.2 ± 4.3 years (P < .001), with more women among DTX (75%) versus STX (40%; P < .001). The DTX kidneys showed higher biopsy scores than the STX organs. DTX were older than STX recipients, but there were no differences in cold ischemia time, delayed graft function, hemorrhagic complications or reinterventions. DTX recipients achieved better CrCl at 1, 3, 6, and 12 months, although only significantly so at 6 months (53.4 ± 19.5 Ml/min versus 44.5 ± 15.6 mL/min; P < .05). Death-censored graft survival was 90% at 3 years for both groups.
  
  
  CONCLUSIONS
  DTX offered good results for graft survival and renal function, despite the more complicated surgery and worse quality of the allografts. DTX allowed the use of ECD kidneys that showed less satisfactory histologic and donor characteristics.
authors.affiliation: Coordination Transplant Unit, Hospital Regional Universitario Carlos Haya de Málaga, Málaga, Spain. mangel.frutos.sspa@juntadeandalucia.es
authors.forename: M A
authors.initials: MA
authors.lastname: Frutos
authors.forename: J J
authors.initials: JJ
authors.lastname: Mansilla
authors.forename: M
authors.initials: M
authors.lastname: Cabello
authors.forename: J
authors.initials: J
authors.lastname: Soler
authors.forename: P
authors.initials: P
authors.lastname: Ruiz
authors.forename: M
authors.initials: M
authors.lastname: Lebrón
authors.forename: V
authors.initials: V
authors.lastname: Baena
authors.forename: D
authors.initials: D
authors.lastname: Hernández
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D014019:Tissue Donors