Audard Vincent, Matignon Marie, Dahan Karine, Lang Philippe, Grimbert Philippe
Service de Néphrologie et Transplantation Rénale, CHU Henri Mondor, et Institut Francilien de Recherche en Néphrologie et Transplantation, Université Paris XII, Créteil, France.
Transpl Int. 2008 Jan;21(1):11-7. doi: 10.1111/j.1432-2277.2007.00543.x. Epub 2007 Sep 10.
The critical shortage of organs available for renal transplantation has led to the consideration of alternative strategies for increasing the donor pool. Recently, the cadaveric kidney donor pool extended to donors who might have been deemed unsuitable in early times, leading to the concept of marginal donors and more recently to the notion of expanded criteria donors. Such organs are eligible for organ donation but, because of extreme age and other clinical characteristics, are expected to produce allograft at risk for diminished post-transplant function. Thus, the challenge is now to reduce the difference between graft outcome from patients grafted with marginal and 'optimal' donors. This implies appropriate transplantation strategies during pre-, peri- and post-transplantation phases including reduction of cold ischemia time, recipient selection, adaptation of immunosuppressive drug regimens, increase in nephron mass by dual kidney transplantation, and improvement in the graft selection process using histological criteria. This review summarizes current definition of a marginal donor and provides some guidance for clinical management of such transplant.
可用于肾移植的器官严重短缺，这促使人们考虑增加供体库的替代策略。最近，尸体肾供体库已扩大到早期可能被视为不合适的供体，从而产生了边缘供体的概念，最近又出现了扩大标准供体的概念。这类器官有资格进行器官捐献，但由于年龄过大和其他临床特征，预计移植后功能会下降，移植的同种异体移植物存在风险。因此，现在的挑战是缩小接受边缘供体和“最佳”供体移植患者的移植结果差异。这意味着在移植前、移植中和移植后阶段采取适当的移植策略，包括缩短冷缺血时间、受体选择、调整免疫抑制药物方案、通过双肾移植增加肾单位数量，以及使用组织学标准改进移植物选择过程。本综述总结了边缘供体的当前定义，并为这类移植的临床管理提供了一些指导。
