Fate of Finally Transplanted Deceased Donor Kidneys Initially Rejected at Other Kidney Transplantation Centers

Abstract

Objective: We conducted this study to determine whether it is justifiable for transplant centers to reject cadaveric donor organs based on marginal organ quality. There is a growing discrepancy between the demand for renal transplants and the number of transplants conducted. For the many patients on the renal transplant waiting list, this translates into increased dialysis-associated morbidity, mortality and a reduced quality of life. Patients and Methods: In our retrospective analysis, we focused on deceased donor kidneys that had been rejected in other transplant centers because of poor organ quality (111 patients) and then accepted for transplantation at our center, compared with a control group consisting of 343 patients. Results: Cold ischemia time was statistically significantly shorter in the control group (11 vs. 12.5 h, p = 0.005). Also, delayed graft function occurred significantly (p = 0.004) more often in the study group (45.9-30.3%). Parameters regarding perioperative data and recipient outcome did not show significant differences and except for 2 time points at 1 week and 3 months, graft function did not differ either. Conclusions: We propose that acceptance criteria for marginal donor kidneys should be expanded. Centers should reconsider their acceptance criteria in the light of these findings as the results of these transplantations may even be much better if the delay due to reallocation and retransport can be spared.

Clinical Outcome of Elderly Kidney Transplant Recipients from Spousal Donors

“…A recent report demonstrated a high incidence of acute rejection episodes in elderly recipients of marginal kidneys, and that the graft from elderly donors may be highly immunogenic [16]. Acceptance criteria for marginal donor kidneys should be expanded [17]. Renal transplantation of a deceased single pediatric donor to an adult recipient can be performed safely and shows a good outcome [18].…”

Optimizing the kidney donor pool: transplanting donor kidneys after partial nephrectomy of masses or cysts

“…Donor organ shortage remains a critical limiting factor for the wider use of renal grafts in transplantation. Several different strategies have been developed in efforts to increase the donor pool, including growth of living donor programs with paired donations and the use of marginal donors, as long as appropriate risks and benefits are considered ( 19 , 20 ). There is no consensus on the definition of marginal donors, which is also evolving over time; however, marginal donors are usually defined as advanced age donors or those with anatomical anomalies or potentially transmissible infections or malignancies ( 21 ).…”

Results of Renal Transplantation on Alloplastic Arterial Grafts

“…Our own experience in a small group of 4 cases also provided no evidence for hypoperfusion of kidneys anastomosed to a prosthetic graft. Centers should reconsider their acceptance criteria of recipients with prosthetic vessel replacement on implantation site like they should do for marginal donor kidneys [27] because of similar results compared with regular recipients and donors.…”