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

• Published in: Einstein (São Paulo, Brazil) Vol. 13; no. 2; pp. 319 - 325
• Main Authors: Matos, Ana Cristina Carvalho de, Requião-Moura, Lúcio Roberto, Clarizia, Gabriela, Durão Junior, Marcelino de Souza, Tonato, Eduardo José, Chinen, Rogério, Arruda, Érika Ferraz de, Filiponi, Thiago Corsi, Pires, Luciana Mello de Mello Barros, Bertocchi, Ana Paula Fernandes, Pacheco-Silva, Alvaro
• Format: Journal Article
• Language: English
• Published: Brazil Instituto de Ensino e Pesquisa Albert Einstein 01.04.2015; Instituto Israelita de Ensino e Pesquisa Albert Einstein
• Subjects: Acute Kidney Injury - surgery; Age Factors; Aged; Creatinine - blood; Delayed Graft Function - mortality; Doadores de tecidos; Donor Selection - organization & administration; Função retardada do enxerto; Graft Survival - physiology; Humans; Insuficiência renal; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - surgery; Kidney Transplantation - methods; Kidney Transplantation - mortality; Length of Stay - statistics & numerical data; MEDICINE, GENERAL & INTERNAL; Middle Aged; Patient Selection; Review; Sobrevivência de enxerto; Survival Rate; Tissue Donors - supply & distribution; Transplante de rim; Graft survival; Renal insufficiency; Transplante de rim; Tissue donors; Insuficiência renal; Sobrevivência de enxerto; Delayed graft function; Função retardada do enxerto; Doadores de tecidos; Kidney transplantation
• ISSN: 1679-4508; 2317-6385; 2317-6385; 1679-4508
• DOI: 10.1590/S1679-45082015RW3147

Given 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.