title: Can only histological evaluation determine the allocation of ECD kidneys?
abstract: BACKGROUND
  There is a recent debate on the "transplantability" of ECD (Expanded Criteria Donors) kidneys and the selection criteria used to allocate them to single or double transplantation. Remuzzi et al. have defined a protocol incorporating pre-transplant donor biopsy to guide the use of older donor organs. They allocated organs as single or double transplants on the basis of histological findings. We aim to show the pros and cons of the only histological evaluation in the allocation of ECD kidneys, to compare the different experiences in United States and Europe and thus to discuss whether this tool should be used alone or included in a comprehensive clinical and histopathological evaluation.
  
  
  CONCLUSIONS
  In the United States many Authors stated that the biopsy actually increases the percentage of kidney discarded and they raised questions about the importance of the biopsy in evaluating ECD kidneys for transplantation. On the other hand, the experiences of the majority of european transplant centers showed that allocating kidneys as single or dual transplant based on biopsy findings may achieve good graft and patient outcomes. Moreover, the experience of some centers as ours showed that kidneys allocated as DKT (Dual Kidney Transplant) on the basis of Remuzzi's score could have been suitable for single transplantation suggesting the need of an adjustment of the Remuzzi Score System. Many Authors, who are in favor of histological evaluation, actually believe that a comprehensive clinical and histopathological assessment before transplantation remains necessary. We lack precise national- or international-based selection criteria to guide clinicians. An adjustment of the Remuzzi Score System could be taken into consideration such as narrowing the indication for DKT from those ECD kidneys with higher scores and including the histological evaluation in a multifactor score.
authors.affiliation: Department of Advanced Biomedical Sciences, Section of General Surgery, University "Federico II", Naples, Italy. carlogrifasi@libero.irt.|Interdepartmental Center for Kidney Transplantation, University "Federico II", Naples, Italy. carlogrifasi@libero.irt.|Dipartimento di Scienze Biomediche Avanzate, Università "Federico II", via Pansini 5, 80131, Napoli, Italy. carlogrifasi@libero.irt.
authors.forename: Carlo
authors.initials: C
authors.lastname: Grifasi
authors.affiliation: Department of Advanced Biomedical Sciences, Section of General Surgery, University "Federico II", Naples, Italy. enzodalessandro2005@libero.it.|Interdepartmental Center for Kidney Transplantation, University "Federico II", Naples, Italy. enzodalessandro2005@libero.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: D'Alessandro
authors.affiliation: Department of Advanced Biomedical Sciences, Section of Anatomic Pathology, University "Federico II", Naples, Italy. maria.darmiento@unina.it.
authors.forename: Maria
authors.initials: M
authors.lastname: D'Armiento
authors.affiliation: Department of Advanced Biomedical Sciences, Section of Anatomic Pathology, University "Federico II", Naples, Italy. severo.campione@gmail.com.
authors.forename: Severo
authors.initials: S
authors.lastname: Campione
authors.affiliation: Department of Advanced Biomedical Sciences, Section of General Surgery, University "Federico II", Naples, Italy. alexscotti@inwind.it.|Interdepartmental Center for Kidney Transplantation, University "Federico II", Naples, Italy. alexscotti@inwind.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Scotti
authors.affiliation: Department of Advanced Biomedical Sciences, Section of General Surgery, University "Federico II", Naples, Italy. gigipelosio@hotmail.com.|Interdepartmental Center for Kidney Transplantation, University "Federico II", Naples, Italy. gigipelosio@hotmail.com.
authors.forename: Luigi
authors.initials: L
authors.lastname: Pelosio
authors.affiliation: Department of Advanced Biomedical Sciences, Section of General Surgery, University "Federico II", Naples, Italy. renda@unina.it.|Interdepartmental Center for Kidney Transplantation, University "Federico II", Naples, Italy. renda@unina.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Renda
mesh_terms: D001706:Biopsy; D005060:Europe; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation / Q000379:methods; D018579:Patient Selection; D040841:Resource Allocation; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014481:United States