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• W2000229721 abstract "In the past 10 years, there has been a dramatic changewithin the kidney transplant population. The incidence andprevalence of end-stage renal disease (ESRD) have beenconsistently rising since the late 1980s. Furthermore, tomake things more complex, the prediction is that in thenext 10 years, people affected by ESRD will duplicate dueto the increment of diabetes, obesity and high blood pres-sure (HBP). Due to the traffic accidents reduction (as lowas they were in the 1960s), optimal young kidney donorsare nowadays more and more an exception. Data from theOrganizacio´n Nacional de Trasplantes (ONT) show that inSpain, traffic accidents reduced from 43 % in the 1990s to6 % in 2012 and cerebrovascular accidents increased from39 % in the 1990s to 62.2 % in 2012. From the kidneytransplant point of view, this has led to the utilization ofsub-optimal donors such as donors older than 60 or withhigh comorbidities. Despite this, the 5-year survival rate ofpatients transplanted from expanded criteria donors issignificantly better than those on dialysis being 86.3 versus67.3 %, respectively [1].Furthermore, although there is raising evidence thatkidneys coming from sub-optimal donors provide goodgraft survival, there are still controversial points to beclarified. For instance, it appears that sub-optimal kidneysmay have a worse early graft function (EGF) and highercomplication rate in the recipient than optimal kidneys.These assumptions have been confirmed with the recentdata published by Barba et al. [2]. They analyzed a largeseries of 407 kidney transplantations, 163 with expandedcriteria (UNOS, 2002). Results revealed that recipientsfrom expanded criteria donors had significant greater fre-quency of hospitalization because of medical problems andgreater frequency of graft loss and delayed graft function(DGF). Moreover, recipient’s age was the only factor witha significant association with surgical complications. Fur-thermore, expanded criteria recipients were associated witha higher risk of minor complication (Clavien I) andpotentially life-threatening risk events (Clavien III and IV).Furthermore, it appears that transplants coming fromexpanded criteria donors may be associated with higherrisk of graft loss; therefore, the number of patients under-going a second transplantation may increase in the future.Whether or not this was true, approximately 10–20 % ofrenal transplants performed annually are re-transplants. It isstill under debate whether an allograft nephrectomy shouldbe performed prior to further kidney transplantation.Generally speaking, an early graft nephrectomy is per-formed in case of early graft failure. However, in case oflate graft loss, the graft is left in place due to its contri-bution to the maintenance of residual diuresis and the lowerrisk of desensitization. Also, the non-functioning graftwould catch HLA antibodies and reduce, together with theimmunosuppression therapy, the formation of antibodies.Recent data from Lucarelli et al. [3] have demonstrated thatallograft nephrectomy prior to re-transplantation does nothave significant influence in the five-year graft survival (90vs. 89 %). Furthermore, patients with prior nephrectomypresent a significant higher risk of complications. Despitethese controversial debates, there is no doubt that kidneytransplant centers have to become more and more familiarwith the aging of the population, and therefore, the toler-ance to accept kidneys coming from sub-optimal donorshas to increase. Friedersdorff et al. [4] have reported their" @default.
• W2000229721 created "2016-06-24" @default.
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• W2000229721 date "2013-05-31" @default.
• W2000229721 modified "2023-09-26" @default.
• W2000229721 title "Editorial for a special issue on kidney transplant" @default.
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• W2000229721 doi "https://doi.org/10.1007/s00345-013-1101-8" @default.
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