Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
The increasing number of possible recipients for kidney transplantation and relatively unchanged number of organ donors has led to consideration of alternative strategies and expansion of deceased donor criteria in order to expand donor pool. Previously, kidneys from expanded criteria donors (ECD) were strongly underestimated because of the conventional opinion suggesting these kidneys to have a higher rate of preservation injury, delayed graft function, rejection and nonfunction. Reducing the difference between graft outcome in patients transplanted from ECD and standard criteria donor (SCD) is one of the goals of many respectable kidney transplantation centers. This assignment includes major concern about reduction of cold ischemia time, recipient selection, novel and adapted immunosuppressive regimens, increased nephron mass by dual kidney transplantation, and using histologic criteria for marginal donor graft selection. There are not many reports on the outcome of kidneys transplanted from donors with acute renal failure and high terminal creatinine. This review presents the exact definition of marginal donor, especially donor with acute renal failure. The management of such grafts during preimplantation and implantation period, outcomes and post-transplantation care are the main assignments for transplantation teams. Recipients of such grafts should be well informed about the possibilities and potential complications and sign their informed consent thereafter. Some respectable studies have shown that under certain, highly controlled conditions, these kidneys can be used safely, with excellent short- and long-term outcomes.Ukupni broj darivatelja organa u posljednje je vrijeme nepromijenjen, a sve veći broj potencijalnih primatelja bubrega na listi čekanja doveo je do razvoja novih strategija i proširenja kriterija kojima se procjenjuje mogući darivatelj organa. Prije se smatralo da su bubrezi darivatelja po proširenim kriterijima lošiji zbog veće učestalosti oštećenja tijekom konzerviranja bubrega, češće odgođene funkcije presatka, odbacivanja i primarne afunkcije organa. Danas je mnogim velikim transplantacijskim centrima cilj smanjenje razlike u ishodu presatka transplantiranog s darivatelja po proširenim kriterijima i darivatelja po standardnim kriterijima. Ovaj cilj uključuje strogu kontrolu u skraćivanju vremena hladne ishemije, odabira primatelja, prilagođene protokole imunosupresije, povećanje mase nefrona s transplantacijom “dva u jedan” i primjenu histoloških kriterija u odabiru grafta marginalnog darivatelja. Zasad nema mnogo objavljenih radova o ishodu transplantiranog bubrega darivatelja s akutnim zatajenjem bubrega ili visokom zadnjom vrijednosti kreatinina u serumu. Namjera ovoga preglednog članka je prikazati najnoviju definiciju marginalnog darivatelja i darivatelja s akutnim zatajenjem bubrega. Primatelji bubrega darivatelja po proširenim kriterijima moraju tijekom prijetransplantacijske obrade biti dobro obaviješteni o svim mogućnostima i komplikacijama takvog postupka, te potpisati obaviješteni pristanak. Poznate studije pokazale su da se pod strogo kontroliranim kriterijima bubrezi darivatelja po proširenim kriterijima mogu sigurno transplantirati odabranim primateljima, s dobrim kratkoročnim i dugoročnim ishodom
