Expanding the pool of kidney donors: use of kidneys with acute renal dysfunction

Abstract

Given the shortage of organs transplantation, some strategies have been adopted by the transplant community to increase the supply of organs. One strategy is the use of expanded criteria for donors, that is, donors aged >60 years or 50 and 59 years, and meeting two or more of the following criteria: history of hypertension, terminal serum creatinine >1.5mg/dL, and stroke as the donor´s cause of death. In this review, emphasis was placed on the use of donors with acute renal failure, a condition considered by many as a contraindication for organ acceptance and therefore one of the main causes for kidney discard. Since these are well-selected donors and with no chronic diseases, such as hypertension, renal disease, or diabetes, many studies showed that the use of donors with acute renal failure should be encouraged, because, in general, acute renal dysfunction is reversible. Although most studies demonstrated these grafts have more delayed function, the results of graft and patient survival after transplant are very similar to those with the use of standard donors. Clinical and morphological findings of donors, the use of machine perfusion, and analysis of its parameters, especially intrarenal resistance, are important tools to support decision-making when considering the supply of organs with renal dysfunction.

Successful transplantation of kidneys from deceased donors with terminal acute kidney injury

“…In addition, Kumar et al [20] showed that 3-year graft survival was 90% in the AKI group (named as ARF), and this rate of survival was similar to that observed among standard criteria donor (SCD) kidneys and was higher in comparison to ECD kidneys. Similarly, data presented by colleagues from Brazil has demonstrated similar 5-year graft survival in AKI and non-AKI groups of 81% and 84% ( p =ns), respectively [21].…”

Sex and the single transplanted kidney

“…It will be an important preclinical finding to address, because organs and patients are frequently taken care of after IRI starts. Additional strategies, such as hypothermic machine perfusion for a prolonged cold ischemia time, reduction of organ extraction time, and inclusion of older (≥60 years) female donors in conjunction with administration of estrogen, can significantly improve graft function and survival (13)(14)(15)(16)(17). The effect of estrogen administration needs to be investigated in large animals before human interventions are studied, as the role of the estrogen receptor in the protective mechanism remains undefined.…”

Renal donor’s life path: memories, resilience and altruism

“…Apesar do transplante renal com doador vivo ser uma modalidade terapêutica muito frequente, não estão totalmente esclarecidas as consequências, em longo prazo, da uninefrectomia para o doador, tornando imperativa a realização de outros estudos que possam auxiliar na melhor compreensão das possíveis repercussões provenientes do ato da doação em vida (6,7,8) .…”

“…A realização deste estudo se justifica pela notoriedade da insuficiência renal crônica constituirse em um grave e crescente problema de saúde pública, com consequente aumento do número de transplantes intervivos no mundo, entretanto diante da necessidade de maiores esclarecimentos quanto a repercussão da uninefrectomia, após longo período, na vida dos doadores renais vivos (6,7) .…”