Living Donation Mitigates Poorer Outcomes in Marginal Recipients

Abstract

Increasing the number of kidney transplantations results in the trend toward the utilization of marginal but acceptable kidneys for deceased donor renal transplantations (DDRT). At the same time, the acceptance of recipients with high medical, surgical, immunological, or psychosocial risks of poor transplant outcomes as we refer to here as “marginal recipients” has been increasing. The combination of both a low quality donor kidney and marginal kidney transplant recipient leads to unfavorable outcomes during the peri- and post-transplant periods. Since some of the risk factors are non-modifiable, living donor renal transplantation (LDRT) with high-quality kidneys and a well-planned operation could potentially mitigate unfavorable outcomes in high risk marginal recipients. In this article, we review common comorbid conditions and risk factors in marginal recipients. We then discuss the different outcomes between DDRT and LDRT in marginal recipients during the perioperative period and suggest potential strategies for utilizing living kidney organs to mitigate the poor outcomes of DDRT.