Organ Grafting Outcomes Involving Elevated Renal Biomarkers in End-of-Life Donors

Abstract

As demand for kidney transplants grows while the availability of donor organs remains relatively stable, transplant programs have begun exploring alternative methods to expand the donor pool. One such approach involves accepting organs from expanded criteria donors (ECD), which were once viewed with caution due to assumptions about increased risks, such as delayed graft function, higher rejection rates, and poor preservation outcomes. Traditionally, these kidneys were considered inferior to those from standard criteria donors (SCD), leading to their underutilization.

Modern transplant programs are now focusing efforts on minimizing the disparity in post-transplant outcomes between recipients of ECD and SCD kidneys. Achieving this involves several strategic adjustments, including minimizing cold ischemia time, implementing tailored immunosuppression protocols, selecting recipients more carefully, and utilizing dual kidney transplants to increase functional nephron mass. Histological assessments have also become an important tool in determining the viability of marginal grafts.

Of particular interest is the use of kidneys from donors who experienced acute renal failure (ARF) or had significantly elevated terminal creatinine levels. Although research in this area remains limited, early findings suggest that such grafts if managed appropriately during retrieval, implantation, and post-operative care can offer promising outcomes. Defining what constitutes a marginal donor, particularly in cases involving ARF, is critical in guiding clinical decisions.

Managing these complex grafts requires careful coordination by the transplant team. It is essential that recipients are thoroughly informed of both the potential benefits and the associated risks before giving consent. When selected under stringent criteria and managed effectively, kidneys from these nontraditional donors have demonstrated successful results in both the short and long term, as shown by studies from experienced transplant centers.