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

Ana Cristina Carvalho De Matos,Ana Paula Fernandes Bertocchi,Gabriela Clarizia,Alvaro Pacheco-Silva,Eduardo José Tonato,Lúcio Roberto Requião-Moura,Thiago Corsi Filiponi,Marcelino De Souza Durão Junior,Luciana Mello De Mello Barros Pires,Rogério Chinen,Érika Ferraz De Arruda

doi:10.1590/s1679-45082015rw3147

Ana Cristina Carvalho De Matos, Ana Paula Fernandes Bertocchi + Show 9 more

Open Access

https://doi.org/10.1590/s1679-45082015rw3147

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Abstract

ABSTRACTGiven 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.

Highlights

Kidney transplant is the replacement therapy of choice for patients with end- stage renal disease, since it provides better quality of life and greater survival for them, as compared to dialysis, besides better costeffectiveness.[1,2]There is, a huge discrepancy between the number of patients on the waiting list and the number320 Matos AC, Requião-Moura LR, Clarizia G, Durão Junior MS, Tonato EJ, Chinen R, Arruda EF, Filiponi TC, Pires LM, Bertocchi AP, Pacheco-Silva A of transplants performed
As per the 2011 Brazilian Dialysis Census, during this period there were more than 90 thousand patients undergoing dialysis.[3]. According to data from January to September 2013 of the Brazilian Registry of Transplants, those active on the waiting list and with a kidney transplant were, respectively, 19,913 and 2,707 patients.[4]. Many patients on the waiting list ended up dying before being called for the transplant
The same is expected, i.e., that aside from the damaged environment, this kidney will recover from the lesions that occurred during the preimplantation period.[1,6]. This lesion may generally be reversible, kidneys of donors with acute kidney injury (AKI) are more susceptible to ischemic injury, which can lead to higher rates of primary graft dysfunction, delayed graft function (DGF), and acute rejection after the transplant.[6] some articles showed an association with shorter graft survival, which is one of the main reasons for organs being discarded, besides the chronic morphological findings.[1,6,16,25]

Summary

Introduction

Kidney transplant is the replacement therapy of choice for patients with end- stage renal disease, since it provides better quality of life and greater survival for them, as compared to dialysis, besides better costeffectiveness.[1,2]There is, a huge discrepancy between the number of patients on the waiting list and the number320 Matos AC, Requião-Moura LR, Clarizia G, Durão Junior MS, Tonato EJ, Chinen R, Arruda EF, Filiponi TC, Pires LM, Bertocchi AP, Pacheco-Silva A of transplants performed. This lesion may generally be reversible, kidneys of donors with AKI are more susceptible to ischemic injury (resulting from warm, cold, and reperfusion ischemia), which can lead to higher rates of primary graft dysfunction, DGF, and acute rejection after the transplant.[6] some articles showed an association with shorter graft survival, which is one of the main reasons for organs being discarded, besides the chronic morphological findings.[1,6,16,25]

Results

Conclusion