Is there a limit for expanding criteria of kidney donors? How far can we go?

Introduction: The lack of organs for transplantation has forced the transplant community to expand the pool of donors. Using expanded criteria donor (ECD) organs is one of the strategies. Although there are organs that do not fit into definition of ECD and remains controversial for transplantation. The aim of this paper is to report the criteria of discharging kidney from transplantation.
Material and methods: 704 patients received cadaveric renal transplants between January 1, 2010 and August 31, 2015. In this time 181 kidneys were discharged from the transplantation – 125 kidneys (63 referred potential donors) were disqu- alified before organ procurement and 56 kidneys were rejected from transplantation during organ storage. Data on donors and preservation parameters were collected. Causes of organ refusal were analysed.
Results: The most common causes of kidney rejection from transplantation was poor donor kidney parameters with pro- bability of kidney irreversible injury (84 kidneys – 46,4%) and malignancy or strong suspicion of malignancy in donor body (44 organs – 24,3%). The next causes of kidneys disqualifications were unsatisfactory parameters during machine per- fusion (20 kidneys – 11%) and hepatitis C virus (HCV) or hepatitis B virus (HBV) infection in donor body with no recipients with negative crossmatch (7 kidneys – 3,9%). The less common causes of kidney rejection from transplantation were anatomical abnormalities (6 organs), nephrolithiasis (5 kidneys) and the others less frequent causes.
Conclusion: Careful kidney selection is recommended in cases of expanded criteria donor kidneys in order to diminish factors that can negatively affect graft function and survival.

Authors:

Agnieszka Jozwik, Piotr Domagala, Edyta Karpeta, Lukasz Gorski et al

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