Marginal Donors in Renal Transplantation

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.

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.

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.

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.