title: When is Transplantation with a "Marginal Kidney" Justifiable?
abstract: The ability of kidney transplantation to improve quality of life has made this therapeutic modality the treatment of choice among renal replacement therapies; however, the continuing organ shortage has forced the use of marginal kidneys as a supplementary source of allografts. It has been repeatedly suggested that failed kidney transplant recipients have greater morbidity and mortality compared with dialysis patients with no renal transplant history. Achieving an optimal balance between the advantages of kidney transplant and disadvantages of allografts with marginal quality is a topic of controversy in transplant medicine. The major and potentially life-threatening complications of immunosuppressive therapies and shorter lifespan following graft failure necessitate a reappraisal of kidney transplant programs from expanded-criteria deceased donors, which can neither necessarily give dialysis patients a better quality of life nor a significant survival benefit, especially in settings with additional diminished graft survival due to HLA-mismatch. It should be offered just to those with short life expectancy and with HLA-matching. The last item is very important in countries without mandatory HLA-matching protocols for kidney transplantation programs.
authors.affiliation: Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza Heidary
authors.initials: AH
authors.lastname: Rouchi
authors.affiliation: Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mitra
authors.initials: M
authors.lastname: Mahdavi-Mazdeh
mesh_terms: D002102:Cadaver; D046148:Donor Selection; D006084:Graft Rejection; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery / Q000628:therapy; D016030:Kidney Transplantation; D017582:Renal Replacement Therapy; D016019:Survival Analysis; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement