Organ shortage represents one of the major limitations to the development of kidney transplantation.To increase the donor pool and to answer the ever increasing kidney request,physicians are recurring to marginal kidn...Organ shortage represents one of the major limitations to the development of kidney transplantation.To increase the donor pool and to answer the ever increasing kidney request,physicians are recurring to marginal kidneys as kidneys from older donors,from hypertensive or diabetic donors and from nonheart beating donors.These kidneys are known to have frequently a worse outcome in the recipients.To date major problem is to evaluate such kidneys in order to use or to discard them before transplantation.The use of such kidneys create other relevant question as whether to use them as single or dual transplant and to allocate them fairly according transplant programs.The pre-transplant histological evaluation,the clinical evaluation of the donor or both the criteria joined has been used and according the time each criterion prevailed over the others.Aim of this review has been to examine the advantages and the drawbacks of any criterion and how they have changed with time.To date any criterion has several limitations and several authors have argued for the development of new guidelines in the field of the kidney evaluation for transplantation.Several authors argue that the use of omic technologies should improve the organ evaluation and studies are ongoing to evaluate these technologies either in the donor urine or in the biopsies taken before transplantation.展开更多
Delayed graft function (DGF) is a common complication occurring most often after deceased donor kidney transplant with several donor characteristics as well as immunologic factors that lead to its development post-tra...Delayed graft function (DGF) is a common complication occurring most often after deceased donor kidney transplant with several donor characteristics as well as immunologic factors that lead to its development post-transplant.These patients require dialysis and close kidney function monitoring until sufficient allograft function is achieved.This has resulted in limited options for DGF management,either prolonged hospitalization until graft function improves to the point where dialysis is no longer needed or discharge back to their home dialysis unit with periodic follow up in the transplant clinic.DGF is associated with a higher risk for acute rejection,premature graft failure,and 30-d readmission;therefore,these patients need close monitoring,immunosuppression management,and prompt allograft biopsy if prolonged DGF is observed.This may not occur if these patients are discharged back to their home dialysis unit.To address this issue,the University of Wisconsin-Madison created a clinic in 2011 specialized in outpatient DGF management.This clinic was able to successfully reduce hospital length of stay without an increase in 30-d readmission,graft loss,and patient death.展开更多
文摘Organ shortage represents one of the major limitations to the development of kidney transplantation.To increase the donor pool and to answer the ever increasing kidney request,physicians are recurring to marginal kidneys as kidneys from older donors,from hypertensive or diabetic donors and from nonheart beating donors.These kidneys are known to have frequently a worse outcome in the recipients.To date major problem is to evaluate such kidneys in order to use or to discard them before transplantation.The use of such kidneys create other relevant question as whether to use them as single or dual transplant and to allocate them fairly according transplant programs.The pre-transplant histological evaluation,the clinical evaluation of the donor or both the criteria joined has been used and according the time each criterion prevailed over the others.Aim of this review has been to examine the advantages and the drawbacks of any criterion and how they have changed with time.To date any criterion has several limitations and several authors have argued for the development of new guidelines in the field of the kidney evaluation for transplantation.Several authors argue that the use of omic technologies should improve the organ evaluation and studies are ongoing to evaluate these technologies either in the donor urine or in the biopsies taken before transplantation.
文摘Delayed graft function (DGF) is a common complication occurring most often after deceased donor kidney transplant with several donor characteristics as well as immunologic factors that lead to its development post-transplant.These patients require dialysis and close kidney function monitoring until sufficient allograft function is achieved.This has resulted in limited options for DGF management,either prolonged hospitalization until graft function improves to the point where dialysis is no longer needed or discharge back to their home dialysis unit with periodic follow up in the transplant clinic.DGF is associated with a higher risk for acute rejection,premature graft failure,and 30-d readmission;therefore,these patients need close monitoring,immunosuppression management,and prompt allograft biopsy if prolonged DGF is observed.This may not occur if these patients are discharged back to their home dialysis unit.To address this issue,the University of Wisconsin-Madison created a clinic in 2011 specialized in outpatient DGF management.This clinic was able to successfully reduce hospital length of stay without an increase in 30-d readmission,graft loss,and patient death.
