Marginal Donors in Renal Transplantation

Background: Kidney transplantation is the therapy of choice for a patient with end-stage renal disease. Although the number of patients with end-stage renal disease is in constant increase, the total number of renal transplants stays almost the same.

Methods: This gap between wait-listed patients for transplantation and the limited number of donations has forced transplant centers to consider kidneys normally refused for transplantation. This so-called expended criteria or marginal donors includes suboptimal quality grafts from cadaver, non-heart-beating donors, or living donors from elderly; hypertensive, diabetic, nephrolithic, or obese patients; or living donors with a history of malignancy, with potential transmissible infections or with renal cysts.

Results: The most common problems with the use of suboptimal kidneys in renal transplantation are delayed graft function and graft failure in the short- and long-term after transplantation. There are many contradictory reports in literature on the results of expanded criteria kidney transplantations. This review aims to summarize positive and negative short- and long-term outcomes of the most commonly used types of marginal kidney donations on renal transplantation, mostly focusing on the recent literature.

Conclusions: We conclude that when both patient and/or living marginal donor accepting nephropathy are well-informed on potential risks taken, renal transplantation from a suboptimal kidney can be a better choice for certain patients with end-stage renal disease.