Nonstandard Donors With Acceptable Risk for Infectious Disease in Kidney And Kidney-Pancreas Transplants: A Promising...

Over the recent decades, requests for kidney transplants have increased in numbers. To cope with scarcity of organs' availability compared to the growing demand, the scientific community has started considering donors who were previously excluded. Recent literature has shown that transplants from these nonstandard donors have outcomes that are better compared to those of patients who remain on dialysis while on the waiting list in terms of both quality of life and life expectancy, with results comparable to transplants from standard donors. Yet, past studies have focused on various classifications of nonstandard donors, overlooking those with acceptable risks. In this article, we further investigate this specific topic. We evaluated 51 transplants performed at our centre (including 2 combined kidney-pancreas transplants) from nonstandard donors with acceptable risk profile, with a focus on cases with increased infectious risk for recipients. The study was conducted over 3 years and evaluated three specific outcomes: possible transmission of infectious diseases; post-transplant mortality from infectious causes; graft function after the transplant. We show that, by strictly adhering to specific precautions, almost no donor-derived infections or infection-related mortality occurred during follow-up and, notably, that renal function at 44 weeks after transplant was comparable to that of recipients from standard donors in the control group. Taken together, our data suggest that the cautious and attentive use of acceptable risk donor organs represents a valuable strategy to counteract organ shortage, ensuring acceptable post-transplant outcomes while maintaining patient safety.