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Review
. 2019 Aug 26;9(4):62-80.
doi: 10.5500/wjt.v9.i4.62.

Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best?

Maurizio Salvadori  1 , Aris Tsalouchos  2
Affiliations
Review

Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best?

Maurizio Salvadori et al. World J Transplant. .

Abstract

Organ shortage represents one of the major limitations to the development of kidney transplantation. To increase the donor pool and to answer the ever increasing kidney request, physicians are recurring to marginal kidneys as kidneys from older donors, from hypertensive or diabetic donors and from non-heart beating donors. These kidneys are known to have frequently a worse outcome in the recipients. To date major problem is to evaluate such kidneys in order to use or to discard them before transplantation. The use of such kidneys create other relevant question as whether to use them as single or dual transplant and to allocate them fairly according transplant programs. The pre-transplant histological evaluation, the clinical evaluation of the donor or both the criteria joined has been used and according the time each criterion prevailed over the others. Aim of this review has been to examine the advantages and the drawbacks of any criterion and how they have changed with time. To date any criterion has several limitations and several authors have argued for the development of new guidelines in the field of the kidney evaluation for transplantation. Several authors argue that the use of omic technologies should improve the organ evaluation and studies are ongoing to evaluate these technologies either in the donor urine or in the biopsies taken before transplantation.

Keywords: Deceased donor score; Donor risk score; Kidney donor evaluation; Kidney evaluation; Kidney risk profile index; Omic technologies; Pre-transplant biopsies.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Main donor, procurement and graft related factors influencing the post-transplant outcomes.
Figure 2
Figure 2
36 month graft survival for donors over 60 years according pre-transplant biopsy.
Figure 3
Figure 3
Five years graft survival for the study population according low, intermediate and high Maryland Aggregate Pathology Index score ranges. MAPI: Maryland Aggregate Pathology Index.
Figure 4
Figure 4
Grade of deceased donor kidney score significantly influenced graft survival at 6 years after transplantation.
Figure 5
Figure 5
Multivariate estimates for graft loss by donor grade (Hazard ratio expressed as mean +/- confidence interval.
See this image and copyright information in PMC

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