Kidney Transplants From Marginal Donors: From Brenner's Abstract to Double Kidney Transplantation in Humans

"In 1993, based on findings from their experimental studies of kidney mass manipulation in a rat kidney transplant model, Barry Brenner and his colleagues postulated that augmenting the number of viable nephrons in kidney transplantation to meet the recipient's metabolic and excretory demands may protect against long-term graft loss. This enlightening idea set the stage for the development and worldwide implementation of dual kidney transplant programs using organs from marginal-including older-donors. This concept was then complemented by robust clinical evidence that showed that a scoring system for pretransplant graft biopsies enabled the successful selection and allocation of kidneys from marginal donors for single or dual transplantation. Although these strategies have contributed significantly to expanding the kidney donor pool, the gap between supply and demand remains large, and closing it will likely require new sources, such as xenotransplantation." Giuseppe Remuzzi.