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Saidi et?al. showed similar graft survival at 2 years posttransplant when comparing ECD, SCD http://www.selleck.cn/products/Staurosporine.html and DCD kidneys, although the mean follow-up for the ECD/DCD subgroup was limited to 27 months [14]. Tojimbara et?al. evaluated short- and long-term outcomes of 256 DCD KTR, of which 29% were combined ECD/DCD kidneys. In this study, there was no difference in overall graft survival of ECD/DCD versus non-ECD/DCD. Additionally, when comparing those with DGF versus immediate graft function, there was no significant difference in the proportion of ECD kidneys with DGF [15]. However, other studies have shown inferior graft survival in recipients of ECD/DCD kidneys when compared to non-ECD/DCD kidneys [16, 17]. These results should be interpreted with caution given the small numbers of combined ECD/DCD kidney transplants in all of these studies, the relatively short follow-up time, and the presence of confounders that were not accounted for in the analyses. Locke et?al. conducted a large retrospective cohort study of over 78?174 deceased donor KTR, including over 2500 DCD kidney transplants, using data from the UNOS registry from 1993 to 2005. Graft survival was explored across donor subgroups (non-ECD, ECD and DCD). Similar to the previous studies, 5-year graft survival was only slightly inferior in the DCD subgroup versus the non-ECD subgroup (79.9% vs. 77.9%, p value http://www.selleckchem.com/products/epz-5676.html non-DCD KTR. However, within the DCD subgroup, the only predictor of graft loss was age. DCD kidneys from donors >50 years of age had similar graft survival as the ECD subgroup, and DCD kidneys from donors http://www.selleckchem.com/products/ly2109761.html existing studies as it evaluates the outcomes of DCD kidney transplantation across ECD subgroups as well as KDRI scores, which takes into account additional risk factors not included in the classical ECD definition. In effect, we explored the role of ECD status or KDRI as an effect modifier of the relation between DCD status and outcomes [19]. Our main findings are perhaps counterintuitive, as one may speculate that the DCD insult should potentiate the impact of other ��marginal�� donor characteristics on kidney transplant outcomes. Although these kidneys qualified as ECD/DCD, their characteristics may be more comparable to ECD/non-DCD kidneys based on the significant overlap in KDRI scores. The relatively small number of ECD/DCD kidneys transplanted over the study period also likely reflects careful organ selection by transplant clinicians and thus generalizing these findings to all combined ECD/DCD kidneys may not be appropriate. However, combined ECD/DCD kidneys with KDRI scores in the range observed in this study may warrant consideration for transplantation.