Department of Abdominal Transplant Surgery, University Hospitals Leuven, KULeuven, Leuven, Belgium.
Curr Opin Organ Transplant. 2011 Apr;16(2):174-9. doi: 10.1097/MOT.0b013e3283446b31.
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.
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.
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.
持久的供体短缺需要开发能够客观评估肾脏移植物质量的工具，从而更安全、更广泛地使用扩展标准供体和心脏死亡后捐献的肾脏。我们总结了在获取前和保存期间可用的当前评估工具。
存在几种结合了较差移植物预后的供体和受者危险因素的供体风险评分，但都缺乏预测能力。移植前肾脏活检中肾小球硬化、肾小管萎缩、间质纤维化和血管损伤的组织学评分可以提供有关实际肾脏状况的可靠、可重复的数据，但缺乏关于其在移植物评估中的应用的前瞻性数据。在机器灌注期间，肾脏阻力和某些灌流生物标志物浓度是延迟移植物功能的独立危险因素，但这两种方法都没有足够的预测能力来允许丢弃肾脏。
用于移植物质量评估的现有工具具有其内在价值，但没有一种方法具有预测特定供体-受者配对移植物结局的必要能力。这可能是由于涉及到众多供体、保存和受者因素。只有将这些因素结合起来，才能提高对移植物结局的预测能力，并允许更安全地使用扩展标准供体和心脏死亡后捐献的肾脏。
