Technic for lengthening the right renal vein of cadaver donor kidneys

As the need for cadaver kidneys for transplantation has increased, and regional and national sharing systems have developed, kidneys have been harvested by retrieval teams in hospitals and communities away from the Transplantation Center. Removal of kidneys by the en bloc technic not only ensures the preservation of multiple arteries, but permits creation of a right renal vein of adequate length.     

Transplantation of cadaver kidneys from a donor with crossed nonfused renal ectopia

Crossed nonfused renal ectopia is a rare congenital renal anomaly. Two kidneys were recovered from a 45-year-old cadaver donor with this anomaly and transplanted successfully. Complex renal anomalies should not prevent the use of such kidneys in cadaver renal transplantation.     

The use of expanded criteria cadaver and live donor kidneys for transplantation.

The use of expanded criteria donors (non-traditional donors) can help lessen the current shortage of kidneys available for transplantation. The use of older donors has accounted for a large measure of the increase in the organ donation rate; however, the most significant factors found to impact on transplant success negatively traditionally have been shown to be extremes of donor age and last-hour urine output. Less significant variables affecting success rates are average systolic blood pressure, terminal serum creatinine, and days of hospitalization. With the appropriate selection of organs from expanded donors, acceptable outcomes can be obtained. When living donors are selected properly, kidneys with anatomic variants without pathologic significance can be used safely. Kidneys with a heightened potential for the development of progressive disease should not be transplanted. Efforts to decrease the cold ischemia time by increasing the use of kidneys from expanded criteria donors may improve the outcome of transplantation further. Advances in surgical techniques, preservation solutions, and methods for predicting eventual long-term renal function in kidneys from expanded donors will be critical in allowing precise selection criteria for kidneys for transplantation, resulting in the optimum use of a scarce and precious resource. Until options such as xenotransplantation become clinically feasible, the challenge will be to identify which donor organs previously considered suboptimal can be used safely to expand the organ donor pool.     

Allocation of deceased donor kidneys: A review of international practices

The demand for kidney transplantation continues to exceed the availability of deceased donor kidneys. Balancing the overarching principles of the optimal use of (utility) and equal access to (equity) this scarce resource requires a sophisticated allocation system. This review will examine how various factors are addressed in allocation systems around the world to strike a balance between utility and equity.     

Primary endoluminal stenting of transplant renal artery stenosis from cadaver and non-heart-beating donor kidneys

This study evaluated the efficacy of primary endovascular stenting in cases of transplant renal artery stenosis (TRAS) from cadaver and non-heart-beating donor kidneys. Patients with TRAS (n = 13) from a single-centre transplant population (n = 476) were treated by primary percutaneous angioplasty and endovascular stenting. The short-term efficacy of this intervention is demonstrated in terms of serum creatinine, glomerular filtration rate (GFR) biochemical, anti-hypertensive medications and mean arterial blood pressure control. Stenting for TRAS was performed in male (n = 10) and female (n = 3) recipients. The median age at transplantation was 55 yr (range 10-67 yr). Stenting occurred at a median duration of 410 d post-transplantation (range 84-5799 d). Mean serum creatinine (pre, 247 micromol/L; post, 214 micromol/L; p = 0.002), GFR (pre, 82.6 mL/min; post, 100.9 mL/min; p < 0.001), arterial blood pressure (pre, 104 mmHg; post, 97 mmHg; p = 0.036) and the number of anti-hypertensive medications required (pre, 3.4; post, 3.0; p = 0.002) showed significant improvement after post-endovascular therapy. There were no serious complications encountered. Primary endovascular stenting of TRAS produces a significant improvement in biochemical parameters of renal graft function and in blood pressure stability, with the benefit of low patient morbidity and single arterial puncture. Primary endoluminal stenting of TRAS is a safe and effective procedure for the treatment of TRAS.     

Pediatric cadaver kidneys for transplantation.

A group of 24 kidneys from donors ranging in age from 1 1/2 to 10 years were transplanted singly into adults and were compared to a group of 44 adult cadaveric kidneys transplanted into adults. There were no vascular complications in either group. There were two urological complications in the 24 pediatric donor cases and none with the adult donor cases. During the first month after transplantation, the mean creatinine clearance was lower in the pediatric donor group; later the function of the pediatric donor kidneys was at least as good as the function of the adult donor grafts. In the group of pediatric donor kidneys, the outcome using kidneys from donors younger than 3 years of age was less satisfactory than for donors 3 to 10 years of age. These data suggest that transplantation of a single pediatric kidney into an adult, particularly if the pediatric donor is at least 3 years of age, will provide satisfactory renal function.     

Sony-W sharing of cadaver kidneys for transplantation

A regional network composed of 12 major medical centers has been organized in southern Ontario, Canada, and upstate New York. During the first four years of experience over 85 cadaver kidneys have been transported to the institution of the waiting recipient. The majority of kidneys were judged to be functioning at thirty days. Simple flushing of the kidney with 500 ml. of Ursol (University of Rochester Solution) is effective in preserving the kidney for fifteen hours.     

Procurement of donor kidneys

Summary Cyclosporine A as an immunosuppressive agent has improved with allograft and patient survival in renal transplantation. As a result more potential recipients are bonofide candidates or patients who were reluctant previously are now seeking renal transplantation as their primary treatment for their end stage renal disease. The supply of donor organs is presently the limiting factor with renal transplantation. The following suggests means for increasing donor numbers as well as improving the use of currently available organs. Topics of discussion are brain death, donor identification, selection and management. The living related donor is recommended as the most desirable and successful donor. Criteria of age, size and anatomical variations are discussed concerning cadaver donor selection. Activities to promote organ recovery are presented.