title: Expanded criteria donor and donation after circulatory death renal allografts in the West of Scotland: Their place in the kidney allocation process.
abstract: BACKGROUND
  Due to the rising disparity between demand and availability, organs from expanded criteria donors (ECD) and donors after determination of circulatory death (DCD) are increasingly used. The purpose of this study was to report outcomes in recipients of ECD and DCD renal allografts from a single centre.
  
  
  METHODS
  A retrospective analysis from a single centre for all renal transplants performed between 2001 and 2010 inclusive was undertaken. SCD (standard criteria donor) and ECD organs were compared, as were DCD and DBD (donation after determination of brain stem death) organs. Baseline data and predefined standard transplant outcomes were collected and compared using appropriate statistical tests. P < 0.05 was defined as significant.
  
  
  RESULTS
  729 renal transplants were performed. Comparing ECD to SCD organs, there was a significant difference in graft survival between groups (logrank for trend, p = 0.032) with ECD organs doing worse than SCD organs. Short-term outcomes showed a similar disparity with a higher 1-year post-transplant creatinine and delayed graft function (DGF) rate in ECD grafts. Nevertheless, outcomes were still clinically acceptable. When comparing DCD to DBD organs, no such differences were apparent, with DCD organs appearing to perform at least as well as DBD organs. In our cohort, unlike some previous studies, DGF rates were similar in both DCD and DBD groups.
  
  
  CONCLUSIONS
  Although ECD organs perform less well than SCD organs, outcomes are still acceptable and our results support their continuing use. When considering DCD organs, our data support the view that they should no longer be necessarily regarded as marginal grafts. Our low DGF rates are perhaps explained by local factors contributing to a short CIT.
authors.affiliation: University of Glasgow, Western Infirmary, Glasgow, UK.
authors.forename: Kerrick
authors.initials: K
authors.lastname: Hesse
authors.affiliation: University of Glasgow, Western Infirmary, Glasgow, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Aitken
authors.affiliation: University of Glasgow, Western Infirmary, Glasgow, UK.
authors.forename: Marc
authors.initials: M
authors.lastname: Clancy
authors.affiliation: University of Glasgow, Western Infirmary, Glasgow, UK. Electronic address: alexvesey@gmail.com.
authors.forename: Alex
authors.initials: A
authors.lastname: Vesey
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006323:Heart Arrest; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D012606:Scotland; D012769:Shock; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000592:standards
keywords: Donation after brain death; Donation after circulatory death; Expanded criteria donor; Organ allocation; Outcomes; Renal transplantation; Standard criteria donor