Dual transplantation of kidneys from expanded criteria donors: maximizing the use of a scarce resource

Manikkam Suthanthiran

This article has no abstract so we have provided the first paragraph of the full text.

Advances in immunology, improvements in surgical skills, refinements in immunosuppressive therapy, and effective infection prophylaxis have resulted in excellent outcomes following renal transplantation. In 2004, 1-year patient survival rates were 98.3% and 95.6% for recipients of living-donor kidneys and deceased-donor kidneys, respectively; corresponding 1-year graft survival rates were 95.0% and 90%.¹ Renal transplantation is preferable to dialysis for almost all patients with end-stage renal disease; however, the ability of clinicians to offer transplantation is thwarted by the disparity between organ supply and demand. The US Organ Procurement and Transplantation Network reported that 62,294 patients were wait listed for a kidney in 2005, but only 12,313 kidneys were recovered from deceased donors in that year, and almost 50% of renal transplantations were of the living donor type.¹ The organ shortage results in a prolonged wait period (median time to transplantation for those registered in 2002: 1,136 days [95% CI 1,110–1,171 days]) and death of patients on the wait list (4,156 reported deaths in 2005).¹

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