Can only histological evaluation determine the allocation of ECD kidneysReport as inadecuate

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BMC Nephrology

, 15:207

Dialysis and Transplantation


IntroductionThere is a recent debate on the -transplantability- of ECD Expanded Criteria Donors kidneys and the selection criteria used to allocate them to single or double transplantation. Remuzzi et al. have defined a protocol incorporating pre-transplant donor biopsy to guide the use of older donor organs. They allocated organs as single or double transplants on the basis of histological findings. We aim to show the pros and cons of the only histological evaluation in the allocation of ECD kidneys, to compare the different experiences in United States and Europe and thus to discuss whether this tool should be used alone or included in a comprehensive clinical and histopathological evaluation.

DiscussionIn the United States many Authors stated that the biopsy actually increases the percentage of kidney discarded and they raised questions about the importance of the biopsy in evaluating ECD kidneys for transplantation. On the other hand, the experiences of the majority of european transplant centers showed that allocating kidneys as single or dual transplant based on biopsy findings may achieve good graft and patient outcomes.

Moreover, the experience of some centers as ours showed that kidneys allocated as DKT Dual Kidney Transplant on the basis of Remuzzi’s score could have been suitable for single transplantation suggesting the need of an adjustment of the Remuzzi Score System. Many Authors, who are in favor of histological evaluation, actually believe that a comprehensive clinical and histopathological assessment before transplantation remains necessary.

SummaryWe lack precise national- or international-based selection criteria to guide clinicians. An adjustment of the Remuzzi Score System could be taken into consideration such as narrowing the indication for DKT from those ECD kidneys with higher scores and including the histological evaluation in a multifactor score.

KeywordsDonor organ shortage Expanded criteria donors Dual kidney transplant Pre-transplant biopsy AbbreviationsSKTSingle kidney transplantation

DKTDual kidney transplantation


ECDExpanded criteria donor

DDSDeceased donor score

UNOSUnited Network for Organ Sharing

KDRIKidney Donor Risk Index

KDPIKidney Donor Profile Index.

Carlo Grifasi, Vincenzo D’Alessandro, Maria D’Armiento contributed equally to this work.

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