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Assessment of donors with sub‐optimal kidney function/structure
Author(s) -
Deborah Verran,
Amanda Robertson,
Jeremy R. Chapman,
Steven J. Chadban
Publication year - 2005
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2005.00463_2.x
Subject(s) - medicine , citation , function (biology) , information retrieval , library science , computer science , biology , evolutionary biology
• Procurement of renal allografts from extended criteria donors should continue to be actively pursued. • Assessment of such potential renal allografts should take into account donor factors, issues at the time of procurement, plus the result of a pre-implantation renal allograft biopsy. • Use of extended criteria donors' renal allografts should only be in the setting of recipient informed consent, weighing up the risks versus benefits. • The decision to accept a deceased donor as suitable for renal donation is the responsibility of both nephrologists and renal surgeons experienced in renal transplantation. • The approach to a deceased organ donor should be to consider age, renal function and renal structure, other co-morbidities, to categorise the kidneys into optimal or marginal. • Extended criteria donor (ECD) kidneys are those which after transplantation, lead to a significantly worse outcome as defined by poor graft survival or inferior renal function. • The predominant features of ECD kidneys are reduced donor renal function and/or structural abnormality. • These kidneys are usually procured from donors with cumulative effects of the following characteristics: age > 55 years, pre-existing hypertension, diabetes mellitus, history of vascular disease, elevated or rising serum creatinine, history of systemic disease or medications known to affect the kidneys, and non-heart–beating donor. • Assessment of ECD kidneys should include surgical assessment at procurement with particular note of renal size, presence of scars/masses, vasculature, and organ perfusion. • Assessment of renal function is by estimated creatinine clearance using the best admission serum creatinine. • Histological assessment of procurement needle biopsy is by taking particular note of percentage glomerulosclerosis, arteriolar disease and interstitial fibrosis. Any identified lesion should also be biopsied. • Assessment of ECD kidneys should determine whether the kidney is acceptable for single transplantation. If not, a decision should be made to determine whether the kidneys are suitable for double transplantation. Double transplantation should not be considered unless the donor creatinine clearance is < 80 mL/min, and the percentage glomerulosclerosis is 20%–40%, or severe vascular disease is present. Organs not transplanted should be managed according to the wishes of the family and or the requirements of the coroner. Allocation Issues • Attention should be made to minimising the cold ischaemic time of ECD kidneys. • Non-heart–beating donor kidneys and dual transplants should be allocated within the state of donation. • There is conflicting evidence on the value of allocating ECD kidneys to either …