Ina Jochmans1, Jacques Pirenne. 1. Department of Abdominal Transplant Surgery, University Hospitals Leuven, KULeuven, Leuven, Belgium. ina.jochmans@med.kuleuven.be
Abstract
PURPOSE OF REVIEW: The enduring donor shortage necessitates the development of tools capable of objectively assessing kidney graft quality and thereby allowing the safer and wider use of expanded criteria donors and kidneys donated after cardiac death. We summarize current assessment tools available prior to procurement and during preservation. RECENT FINDINGS: Several donor risk scores, combining donor and recipient risk factors of inferior graft outcome, exist but all lack predictive power. Histological scoring of glomerulosclerosis, tubular atrophy, interstitial fibrosis, and vascular damage in pretransplantation kidney biopsies can supply reliable, reproducible data on the actual kidney state but prospective data on their use in graft assessment are lacking. Renal resistance and certain perfusate biomarker concentrations during machine perfusion are independent risk factors of delayed graft function, but neither method has sufficient predictive power to allow kidney discard. SUMMARY: Available tools for graft quality assessment have their intrinsic value but none offer the necessary power to predict graft outcome for a specific donor-recipient pair. This is probably due to the multitude of donor, preservation, and recipient factors at stake. Only combining these factors might improve prediction of graft outcome and allow safer use of expanded criteria donors and kidneys donated after cardiac death.
PURPOSE OF REVIEW: The enduring donor shortage necessitates the development of tools capable of objectively assessing kidney graft quality and thereby allowing the safer and wider use of expanded criteria donors and kidneys donated after cardiac death. We summarize current assessment tools available prior to procurement and during preservation. RECENT FINDINGS: Several donor risk scores, combining donor and recipient risk factors of inferior graft outcome, exist but all lack predictive power. Histological scoring of glomerulosclerosis, tubular atrophy, interstitial fibrosis, and vascular damage in pretransplantation kidney biopsies can supply reliable, reproducible data on the actual kidney state but prospective data on their use in graft assessment are lacking. Renal resistance and certain perfusate biomarker concentrations during machine perfusion are independent risk factors of delayed graft function, but neither method has sufficient predictive power to allow kidney discard. SUMMARY: Available tools for graft quality assessment have their intrinsic value but none offer the necessary power to predict graft outcome for a specific donor-recipient pair. This is probably due to the multitude of donor, preservation, and recipient factors at stake. Only combining these factors might improve prediction of graft outcome and allow safer use of expanded criteria donors and kidneys donated after cardiac death.
Authors: I E Hall; R S Bhangoo; P P Reese; M D Doshi; F L Weng; K Hong; H Lin; G Han; R D Hasz; M J Goldstein; B Schröppel; C R Parikh Journal: Am J Transplant Date: 2014-02-24 Impact factor: 8.086
Authors: C R Parikh; I E Hall; R S Bhangoo; J Ficek; P L Abt; H Thiessen-Philbrook; H Lin; M Bimali; P T Murray; V Rao; B Schröppel; M D Doshi; F L Weng; P P Reese Journal: Am J Transplant Date: 2016-02-17 Impact factor: 8.086
Authors: Jeremy Puthumana; Isaac E Hall; Peter P Reese; Bernd Schröppel; Francis L Weng; Heather Thiessen-Philbrook; Mona D Doshi; Veena Rao; Chun Geun Lee; Jack A Elias; Lloyd G Cantley; Chirag R Parikh Journal: J Am Soc Nephrol Date: 2016-07-22 Impact factor: 10.121
Authors: Jon N Marsh; Matthew K Matlock; Satoru Kudose; Ta-Chiang Liu; Thaddeus S Stappenbeck; Joseph P Gaut; S Joshua Swamidass Journal: IEEE Trans Med Imaging Date: 2018-06-27 Impact factor: 10.048