Kidney transplantation from marginal donors

Veroux, Massimiliano; Puliatti, Carmelo; Cappello, D.; Macarone, M.; Puliatti, D; Vizcarra, Darwin

doi:10.1016/j.transproceed.2004.02.012

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…However, the long term survival of the grafts is not yet optimal ( 275 – 277 ). This is due to organ shortage and the subsequent access to extended-criteria and brain dead donors ( 278 – 281 ). Moreover, the main cause of kidney transplantation failure is the development of interstitial fibrosis and tubular atrophy, which is a progressive kidney dysfunction associated also with vascular occlusion and glomerulosclerosis ( 282 , 283 ).…”

Section: Msc Therapy In the Treatment Of Kidney Diseases: State Of Thmentioning

confidence: 99%

Stem/Stromal Cells for Treatment of Kidney Injuries With Focus on Preclinical Models

et al. 2018

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Within the last years, the use of stem cells (embryonic, induced pluripotent stem cells, or hematopoietic stem cells), Progenitor cells (e.g., endothelial progenitor cells), and most intensely mesenchymal stromal cells (MSC) has emerged as a promising cell-based therapy for several diseases including nephropathy. For patients with end-stage renal disease (ESRD), dialysis or finally organ transplantation are the only therapeutic modalities available. Since ESRD is associated with a high healthcare expenditure, MSC therapy represents an innovative approach. In a variety of preclinical and clinical studies, MSC have shown to exert renoprotective properties, mediated mainly by paracrine effects, immunomodulation, regulation of inflammation, secretion of several trophic factors, and possibly differentiation to renal precursors. However, studies are highly diverse; thus, knowledge is still limited regarding the exact mode of action, source of MSC in comparison to other stem cell types, administration route and dose, tracking of cells and documentation of therapeutic efficacy by new imaging techniques and tissue visualization. The aim of this review is to provide a summary of published studies of stem cell therapy in acute and chronic kidney injury, diabetic nephropathy, polycystic kidney disease, and kidney transplantation. Preclinical studies with allogeneic or xenogeneic cell therapy were first addressed, followed by a summary of clinical trials carried out with autologous or allogeneic hMSC. Studies were analyzed with respect to source of cell type, mechanism of action etc.

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Section: Msc Therapy In the Treatment Of Kidney Diseases: State Of Thmentioning

confidence: 99%

Stem/Stromal Cells for Treatment of Kidney Injuries With Focus on Preclinical Models

et al. 2018

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“…22 Patients with ESRF should have the opportunity, with informed consent, to choose to continue waiting for an ideal graft or receive a marginal kidney from a live donor. Strategies have been suggested 15 to improve the function of a marginal kidney, referring both to deceased and live donors, such as reduction in cold ischaemia time, delay in the initiation of calcineurin inhibitors until renal function is satisfactory and the transplantation of such organs in a healthy population over 60 years old (old-to-old programme). More recently the belief that moderate blood pressure, adequately treated, as an isolated medical abnormality, poses little risk to a patient's renal function and has led some centres to accept such individuals as potential donors.…”

Section: Discussionmentioning

confidence: 99%

“…Yet studies show that using kidneys from marginal health donors improves patients' quality of life 13,14 with an associated benefit in life-expectancy when compared with maintenance dialysis. 8,15…”

Section: Introductionmentioning

confidence: 99%

Ethical issues in live donor kidney transplantation: attitudes of health-care professionals and patients towards marginal and elderly donors

et al. 2011

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Acceptance of elderly or marginal health individuals as kidney donors is debated, with practices varying between centres. Transplant recipients, live kidney donors and health-care professionals caring for patients with renal failure were surveyed regarding their views on live donor kidney transplantation (LDKT) of marginal health (diabetes, hypertension, atherosclerosis, obesity, etc.) and elderly donors. Participants were recruited within a tertiary renal and transplant centre and invited to participate in focus groups and structured interviews. They also completed an anonymous questionnaire. Of 464 participants who completed the questionnaire (36% health-care professionals and 64% patients), 49% and 64%, respectively, stated that marginal and elderly donors should be accepted for LDKT. In the structured interviews, emphasis was given to presenting to donor, recipient and their respective families a calculated risk regarding the effect that either a nephrectomy or transplant has on long-term quality of life. Participants stated that an independent third party in addition to the transplant team should discuss involved risks. Issues of ‘how desperate’ the recipient's situation is should also be considered. Health-care professionals stated that regardless of the strength of will of an individual to donate a kidney (despite age, health problems or personal risk), they should always have the right to say ‘no’ if performing a specific LDKT was against their professional and ethical values. About half of those surveyed considered that marginal health and elderly donors were acceptable for LDKT. Emphasis was given to the explanation to donors and recipients of the risks involved in such transplantation.

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