The impact of donor renal abnormalities in cadaver transplantation

The original specifications for transplantable cadaver donor kidneys were extremely stringent. Only kidneys from the left side were used by some centers because of the fear of having an inadequate, short renal vein on the right side. Over time there has been gradual liberalization of the rules for transplantation of cadaver kidneys culminating with recent reports of the use of highly abnormal kidneys in some situations. Horseshoe kidneys, hydronephrotic and ectopic kidneys, kidneys with ureteral stones, and kidneys from diabetic or anencephalic newborn donors have all been transplanted successfully. Normal renal function has been reported after transplantation of organs with short renal blood vessels, short ureters and extremely long preservation times up to 96 hours. If it is safe to use kidneys that are quite abnormal for cadaver kidney transplantation then the wastage rate might be reduced and the overall cost of cadaver organ recovery might decline. If on the other hand there is accumulative harm in using kidneys with one or more abnormalities then it is important we recognize such dangerous constellations and avoid them in our transplant decision-making. The Quality Control Program (QCP) of the South-Eastern Organ Procurement Foundation (SEOPF) has been reviewed to see if the use of abnormal kidneys has an impact on the success of cadaver transplants.

Duke Scholars

Author Ralph Randal Bollinger Surgery