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So, renal histology is used by several groups to evaluate the viability of ECD kidneys. Dual kidney transplantation (DKT) is one of such strategies to increase the donor pool by optimizing marginal donor organ acceptance. The rationale for using two kidneys relies on the ��nephron mass�� theory; if the transplantation outcome by ECD kidneys is poor enough to discard them, perhaps providing double nephron mass by transplanting two kidneys in one recipient could http://www.selleckchem.com/products/ly2109761.html improve the final outcome (7,8). In this direction, in a seminal paper authors from the ��Dual Kidney Transplantation Group�� reported that 2-year survival of kidneys from donors older than 60 years allocated to single kidney transplantation (SKT) or DKT according to preimplantation biopsy score was similar to that of younger kidneys from optimal donors and exceeded 20% the survival of older kidneys transplanted as SKT without pretransplant histological evaluation (9). Lucarelli et al. (10) described that these results were maintained after 5 years. Other groups are using different histological criteria to allocate older kidneys to DKT or SKT. In Spain, one group reported good results just by using percentage of glomerulosclerosis as guidance (11). On the other hand, the United Network for Organ Sharing (UNOS) guidelines consider DKT if donor age is greater than 60 years, glomerular filtration rate (GFR) is less than 65 mL/min, there is rising http://www.selleckchem.com/products/epz-5676.html serum creatinine at time of organ recover (greater than 2.5 mg/dL), history of diabetes or hypertension and glomerulosclerosis between 15% and 50%. By this approach, Gill et al. (12) showed similar 4-year graft survival in DKT and ECD transplants (defined those older than 70 years or 50�C59 if having two of the following: hypertension, diabetes, cerebrovascular cause of death, terminal serum creatinine greater than 1.5 mg/dL). Finally, French groups suggest histological assessment does not provide any advantage in comparison to donor GFR to allocate ECD organs (13). All these different approaches illustrate http://www.selleck.cn/products/Staurosporine.html the lack of consensus among the transplant community for transplanting one, two or zero kidneys from ECD (4). In the ��old-for-old�� program at Bellvitge Hospital, we allocate older kidneys to SKT or DKT depending on histology evaluated according to the DKT algorithm (8). The main objectives of this study are to analyze the long-term results of our old-for-old program, to compare the outcomes of SKT and DKT and to identify independent predictors of patient and graft survival. Since December 1996, we allocate kidneys from older ECD to SKT or DKT depending on renal histology as described elsewhere (8,14). The protocol was approved by the Bellvitge Hospital Institutional Review Board. ECD were those older than 60 years, proteinuria