With the rising rates of obesity, type II diabetes and an aging population, the number of individuals developing end-stage renal disease (ESRD) is increasing globally. With more individuals seeking kidney transplantation, the gap between those waiting for a transplant, and available kidney allografts, is unfortunately widening. Efforts with more potent immunosuppressive agents, protocols with desensitization, educational efforts, altruistic donors, and swap programs have made live donor transplants more accessible.
However, the expansion of live donor programs alone cannot accommodate all those on transplant waiting lists so nephrology care providers are looking more closely at the practices of using deceased donor allografts. Many of these allografts are discarded following biopsy, due to disease or damage during organ procurement. Discard rates of up to 20% have been reported in the US. The difference in discard rates in other countries such as the 9% rate in France raise the question about possible differences in criteria for discards.
我们要丢弃太多的肾脏吗？
本周BMC Nephrology，，，，Lee等。报告在韩国医院利用70岁以上已故捐助者的同种异体移植方面，肌酐水平> 3.0mg/dl或GFR小于30ml/min。在这些情况下，将这两个肾脏都移植到往往年龄较大的受体中，并且更可能患有合并症，例如高血压和糖尿病。尽管对15例双肾脏移植案例进行了一项小型研究，但与124名标准标准捐赠者（SCD）的接受者和80名扩展标准供体捐赠者（ECD）的接受者，但阳性结果至少需要检查当前实践的检查，这些实践可能导致丢弃同种异体移植。两组的患者生存率，Nadir肌酐和Nadir肌酐的时间相似。这个单一中心的经验提示了一个问题 - 与保持透析和更好的生活质量相比，我们是否会丢弃太多肾脏，这些肾脏可能会为老年接受者提供合并症可能会改善其生存期吗？
由于缺乏乙型肝炎阳性受体而导致的丙型肝炎阳性同种异体移植物的认识从事于protocols allowing for transplantation into hepatitis C negative recipients while using new antiviral therapies. Beyond the development of new protocols, we need to look at current policies and regulations that may impact on the decisions by transplant centers to use certain organ offers.
在美国，法规医疗保险服务中心（CMS）通过报告患者和移植物的存活率来帮助保护患者，以及这可能会影响移植中心，以至于对使用年龄较大且具有更多合并症的捐助者的同种异体移植物不太保守。在2016年对低性能分数移植中心的分析中，斯科尔德等。在随后的几年中，结果将有所改善，但这伴随着较高的患者从等待名单中删除（28.6次删除 /1000年随访，p<0.001）和移植率下降（-11.9/1000年随访，p<0.001）。虽然重要的是要以成功的移植目标查看所有同种异体移植商品，但我们在使用少于完美的肾脏方面太快还是过于保守？
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