Older kidneys donor transplantation: five years' experience without biopsy and using clinical laboratory and macroscopic anatomy evaluation.
BACKGROUND
The exponential increase in organ demand is not associated with a similar increase of available kidneys. This emergency led to expanded criteria to consider a kidney transplantable. The aim of this retrospective study was to explain our use of older donor kidneys without biopsy.


METHODS
Between 2000 and 2005, 58 older kidneys were harvested: 27 were transplanted in our center; 13 were discarded; and 18 were transplanted in other centers. We considered 3 factors to define kidney quality: macroscopic anatomy, multiple factors linked to the donor, and clinical-laboratory data. After transplantation, we observed the patients for at least 1 year and up to 6 years.


CONCLUSIONS
At 1 year, 24/27 (89%) patients had a functional kidney, 2 patients showed an initial renal failure and 1 patient lost the kidney. At maximum follow-up, 19 patients (70%) had functional kidneys, 4 with initial renal failure. These results compared with the kidneys harvested using Standard Donor Kidney Criteria are acceptable. Obviously we need long-term follow-up to increase, the amount of data and obtain a definitive outcome.


CONCLUSIONS
Biopsy is the gold standard for the definition of an older kidney's quality. When a biopsy is not feasible, the study of the macroscopic anatomy the kidney's donor and of some donor's parameters represent an acceptable biopsy alternative, being able to rescue some organs that would be otherwise lost.
Santangelo
M
M
General, Thoracic and Vascular Surgery Department, O U of General Surgery and Organ Transplantation, University of Naples Federico II, Naples, Italy. miichele.santangelo@unina.it
Zuccaro
M
M
De Rosa
P
P
Tammaro
V
V
Grassia
S
S
Federico
S
S
Ciotola
A L
AL
Spinosa
G
G
Renda
A
A
D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology* / Q000473:pathology; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000401:mortality / Q000473:pathology / Q000502:physiology*; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome