title: Evolution of Renal Transplant Practice Over the Past Decade: A U.K. Center Experience.
abstract: OBJECTIVE
  As renal transplantation continues to evolve, there appears to be a change in both donor and recipient populations. Traditional markers of high-risk donor (e.g. donation after cardiac death [DCD]/expanded criteria donor [ECD]) and recipient (e.g. obese, highly sensitized) operations appear to be more common without any noticeable worsening of patient outcome. The present study aimed to compare outcome and define the change in donor and recipient populations for cadaveric transplants over a 10-year period at a large U.K. center.
  
  
  METHODS
  Single-center analysis of all adult patients undergoing cadaveric renal transplantation between January 2004 and January 2014 (n = 754). Transplants were divided into 3 groups (early, middle, and late) depending on the era, with donor, recipient and outcomes compared.
  
  
  RESULTS
  There were considerable changes in both donor and recipient factors between the 3 eras, with a greater proportion of high-risk operations performed, as reflected by significant increases in Donor Risk Index (median: 1.11-1.16, P = .022), and the proportions of ECD (22.2%-33.9%, P = .003) and DCD kidneys (10.8%-19.4% P = .011). However, 1-year graft survival was comparable between the eras, with a decrease in the average 1-year serum creatinine between the early and late cohort (median: 161 μmol/L vs 132 μmol/L, P < .001). There was no significant increase in body mass index (BMI) in either the donor or recipient population across the eras.
  
  
  CONCLUSIONS
  Improvement in transplant outcome continues despite a greater proportion of transplants previously considered as high risk being performed. This is likely to reflect a considerable improvement in pre- and postoperative management. BMI remains a major continuing block to transplantation.
authors: Department of Renal Surgery, University Hospitals Birmingham, Queen Elizabeth, UK; School of Immunity and Infection, University of Birmingham, Birmingham, UK.
authors: J
authors: J
authors: Nath
authors: Department of Renal Surgery, University Hospitals Birmingham, Queen Elizabeth, UK. Electronic address: melfield@doctors.org.uk.
authors: M
authors: M
authors: Field
authors: School of Immunity and Infection, University of Birmingham, Birmingham, UK.
authors: S R
authors: SR
authors: Ebbs
authors: School of Immunity and Infection, University of Birmingham, Birmingham, UK.
authors: T
authors: T
authors: Smith
authors: Department of Renal Surgery, University Hospitals Birmingham, Queen Elizabeth, UK.
authors: D
authors: D
authors: McGrogan
authors: Department of Renal Surgery, University Hospitals Birmingham, Queen Elizabeth, UK.
authors: J
authors: J
authors: Al-Shakarchi
authors: Wolfson Computer Laboratory, University Hospitals Birmingham, Queen Elizabeth, UK.
authors: J
authors: J
authors: Hodson
authors: Department of Renal Surgery, University Hospitals Birmingham, Queen Elizabeth, UK.
authors: S
authors: S
authors: Mellor
authors: Department of Renal Surgery, University Hospitals Birmingham, Queen Elizabeth, UK.
authors: A
authors: A
authors: Ready
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005544:Forecasting; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000639:trends*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult