Dual Kidney Transplantation.docVIP

I. Codreanu et al.: Dual Kidney Transplantation Transplantationsmedizin 2004, 16. Jahrg., S. 13 Dual Kidney Transplantation I. Codreanu , P. Cravedi , 1,2 1 1 1 G. Remuzzi , P. Ruggenenti Organ availability still represents a major problem for renal trans- plantation programs. The number of patients awaiting transplanta- tion greatly exceeds the available donor organs, and this discrep- ancy continues to grow. The attempt to reduce this gap inevitably led to consideration for kidney transplantation of organs from older donors or from donors with hypertension, diabetes or other renal diseases. This review focuses on the different strategies adopted to increase transplant activities by expanding the criteria for donor and recipient selection without exposing the recipient to the drawbacks of inadequate nephron mass supply. To this purpose some centers restricted the transplantation of suboptimal organs to recipients with reduced metabolic requirements. Others made the opposite and increased nephron mass supply by simultaneously transplanting two suboptimal kidneys to the same recipient. In both cases, a critical aspect is to assess whether the filtration power provided with the grafts was fit with the metabolic require- ment of the recipients. To this purpose, morphological parameters assessed on kidney biopsies at the time of donor evaluation may serve to quantify the preserved tissue and to predict the post- transplant performance of the graft. The histological evaluation may also help to discriminate chronic irreversible lesions from acute changes that may account for a transiently impaired renal function in the donor, that may recover post-transplant. Prelimi- nary reports of dual transplants from expanded criteria donors have shown a remarkably good short-term renal funct