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In this multivariate analysis, the positive effect of BDdur on lower DGF incidence was not an independent effect, but could be explained by donor age. Similarly, the positive effect of BDdur on GS could be explained by donor age and chance of anti-rejection therapy in the first year after transplantation. In the subgroup of donors aged ��55?years, however, BDdur did have an independent negative effect on the odds for developing DGF. Although the odds ratio seems rather close to 1.0 at first sight (0.996), it should be noted that BDdur was included in the model as a continuous variable, in contrast to the previously published study of Kunzendorf et?al. [9] in which BDdur was a binary variable classified as ��long BDdur�� or ��short BDdur.�� Our model shows that for all DBD donors aged ��55?years, each hour increase of BDdur in the donor reduces the odds of developing DGF in the recipient by 0.4%. Therefore, http://www.selleck.cn/products/s-gsk1349572.html based on this study, we would carefully recommend not to rush with organ recovery procedures in DBD donors ��55?years of age. To our surprise http://www.selleckchem.com/products/z-vad-fmk.html the median BDdur in this US cohort was 23.8?h. In Kunzendorf��s European study, performed within the Eurotransplant organ sharing network, the median BDdur was 470?min, or 7.8?h. When we simulated his analysis in our OPTN dataset, dividing the population into donors with BDdur 470?min, we could reproduce his findings with respect to DGF, but not for GS. However, in our study population donors with BDdur http://www.selleckchem.com/products/ly2157299.html a satisfactory explanation for this difference between American OPTN data and European data, but we found that median donor BDdur times from kidneys allocated to our transplant center in Groningen, The Netherlands, were also only 10.5?h. From personal communication with US procurement coordinators, we found that the difference can be explained by two factors. First, in the US more time is spent with the donor��s relatives to obtain consent for donation, thus lengthening the period between declaration of brain death and the preparations for organ retrieval. Second, the donor operation is usually scheduled to take place during office hours, whereas in Europe, the donor operation is often performed as soon as possible, and even in the middle of the night. As organs are recovered early, recipients also have to be found as quickly as possible. This may lead to more complicated logistics, with transplant centers under higher pressure to accept an organ offer. As BDdur is much longer in our study population when compared with Kunzendorf��s series, a pitfall in our analysis could be a ��stable donor�� selection bias: Donors with longer BDdur have a prolonged ICU stay, which increases the risk of hemodynamical instability. This may lead to higher numbers of organs that are not retrieved and more organs that are discarded after recovery.