Maggiore Umberto, Cravedi Paolo
aTrapianti Rene-Pancreas (U.O.C. Nefrologia), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy bRenal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Curr Opin Organ Transplant. 2014 Aug;19(4):372-80. doi: 10.1097/MOT.0000000000000081.
The current era of organ shortage has necessitated a widening of criteria for donation, considering donors who would have been considered unsuitable before. This review summarizes the recent advances in strategies to maximize the use of marginal kidneys without compromising the outcomes.
Various strategies have been studied and implemented to optimize procurement and allocation of marginal kidneys, and to preserve their function. In particular, a growing number of transplant centers are using donors after circulatory death. Whereas normothermic ex-vivo and postmortem perfusion are promising procedures to improve the outcomes of marginal grafts in the future, dual-kidney transplantation is a viable approach which is at present potentially underutilized. Despite active research on new strategies to evaluate organ quality, pretransplant biopsy assessment currently remains the most reliable method. The practice of using living donors with advanced age is supported by available evidence, whereas the use of young living donors with minor medical abnormalities needs further investigation.
Progress has been made in the recent years, clarifying the best criteria for evaluating, recovering, and allocating marginal kidney donors. However, further research is needed, with special regards to the criteria for using marginal living-kidney donors.
在当前器官短缺的时代，有必要扩大捐赠标准，将以往被认为不合适的捐赠者纳入考虑范围。本综述总结了在不影响结果的前提下最大化利用边缘性肾脏的策略方面的最新进展。
已经研究并实施了各种策略来优化边缘性肾脏的获取与分配，并保护其功能。特别是，越来越多的移植中心正在使用心脏死亡后的捐赠者。虽然常温体外和尸检灌注是未来改善边缘性移植物结果的有前景的方法，但双肾移植是一种可行的方法，目前可能未得到充分利用。尽管在评估器官质量的新策略方面进行了积极研究，但移植前活检评估目前仍然是最可靠的方法。现有证据支持使用高龄活体捐赠者，而使用有轻微医学异常的年轻活体捐赠者则需要进一步研究。
近年来已取得进展，明确了评估、获取和分配边缘性肾脏捐赠者的最佳标准。然而，仍需要进一步研究，特别是关于使用边缘性活体肾脏捐赠者的标准。
