A Review of Current and Emerging Trends in Donor Graft-Quality Assessment Techniques

Abstract

The number of patients placed on kidney transplant waiting lists is rapidly increasing, resulting in a growing gap between organ demand and the availability of kidneys for transplantation. This organ shortage has forced medical professionals to utilize marginal kidneys from expanded criteria donors (ECD) to broaden the donor pool and shorten wait times for patients with end-stage renal disease. However, recipients of ECD kidney grafts tend to have worse outcomes compared to those receiving organs from standard criteria donors (SCD), specifically increased risks of delayed graft function (DGF) and primary nonfunction incidence. Thus, representative methods for graft-quality assessment are strongly needed, especially for ECDs. Currently, graft-quality evaluation is limited to interpreting the donor’s recent laboratory tests, clinical risk scores, the visual evaluation of the organ, and, in some cases, a biopsy and perfusion parameters. The last few years have seen the emergence of many new technologies designed to examine organ function, including new imaging techniques, transcriptomics, genomics, proteomics, metabolomics, lipidomics, and new solutions in organ perfusion, which has enabled a deeper understanding of the complex mechanisms associated with ischemia-reperfusion injury (IRI), inflammatory process, and graft rejection. This review summarizes and assesses the strengths and weaknesses of current conventional diagnostic methods and a wide range of new potential strategies (from the last five years) with respect to donor graft-quality assessment, the identification of IRI, perfusion control, and the prediction of DGF.

An enhanced level of VCAM in transplant preservation fluid is an independent predictor of early kidney allograft dysfunction

“…Levels of GM-CSF and leptin in donor kidney preservation fluid have been identified as potential markers predicting short-term post-transplantation kidney function ( 24 ). Recent reviews report the potential of imaging or new technologies allowing assessment of donor-related biomarkers that could reflect graft quality ( 7 , 9 ). Donor-related biomarkers have been described in HMP perfusate and in donor urine ( 11 ), and have identified glutathione S-transferase (GST) and lactate dehydrogenase (LDH) elevation as the most studied and promising biomarkers to predict short-term graft function.…”

“…Several attempts have been made to identify recipient biomarkers that can predict early graft dysfunction ( 7 , 9 , 10 ).However, recipient biomarkers are difficult to assess in the decision to allocate deceased-donor kidneys in current clinical practice. A definition of donor-related biomarkers in kidney transplant biopsies or in serum or urine fluids could be a valuable tool to assess the pre-transplant quality of kidneys and orient early management of risk after transplant surgery ( 11 , 12 ).These biomarkers are limited by the accessibility of donor-derived fluid or procurement biopsies during the clinical transplantation procedure ( 10 , 13 , 14 ).…”

Solid-phase microextraction: a fit-for-purpose technique in biomedical analysis

“…Although the availability of organs is the major challenge associated with transplantation, the lack of effective preservation methods and reliable non-/low-invasive tools for assessing organ quality are also significant issues. In general, indirect methods are used to evaluate graft quality, while the histological assessment of a single biopsy is allowed in some cases for direct tissue analysis [ 14 ]. However, it is known that a graft undergoes significant biochemical changes (e.g., related to ischemia or oxidative stress) during its preservation, which can last for hours.…”

Itaconic acid facilitates inflammation abatement and alleviates liver ischemia-reperfusion injury by inhibiting NF-κB/NLRP3/caspase-1 inflammasome axis

“…Accumulated inflammatory cytokines then enter the body with the blood, resulting in a violent inflammatory factor storm and serious damage to the recipient body (Figure 1A). IRI not only affects the safety of transplantation, but also determines the recovery of donor liver function after transplantation (4,5).…”