Living donor renal transplantation: recent developments and perspectives
- 1 January 2007
- journal article
- review article
- Published by Springer Science and Business Media LLC in Nature Clinical Practice Nephrology
- Vol. 3 (1), 31-41
- https://doi.org/10.1038/ncpneph0383
Abstract
A new source of organs became available following the first successful transplantation of a kidney from a living donor half a century ago. Since then, expanding the living donor pool has been a priority. This appraisal of strategies used to increase the number of living kidney donors focuses on transplantation across ABO and HLA barriers, and extending selection criteria to include elderly and obese donors, and those with hypertension. Renal transplantation is the optimal treatment for patients of all ages with end-stage renal disease. Life expectancy of the population in general is increasing consistently, as is the age of the dialysis population. Consequently, the average ages of kidney donors and recipients are rising. The combination of a growing number of patients with end-stage renal disease and a shortage of organs poses a significant challenge to the transplant community. Donor shortage is associated with unfavorable consequences (e.g. prolonged waiting time, and compromised graft and patient survival). As such, multidirectional efforts are required to expand the donor pool. Increasing the frequency of living donation seems to be an efficient solution. Living donation is associated with superior results for the recipient, and relatively benign long-term outcomes for donors. Reluctance to use organs from living donors whose eligibility was previously considered marginal (e.g. elderly donors) is declining. Although increased donor age is associated with reduced graft survival rates, this should not preclude use of older living donors; transplantation is definitely superior to remaining on dialysis. Thorough, standardized evaluation and careful screening for premorbid conditions in both elderly donors and elderly recipients are essential. Here, we present various options for expanding the living donor pool, with emphasis on the utilization of elderly living donors and transplantation in elderly recipients.This publication has 68 references indexed in Scilit:
- Kidney transplantation and wait-listing rates from the international Dialysis Outcomes and Practice Patterns Study (DOPPS)Kidney International, 2005
- Expanding the donor pool to increase renal transplantationNephrology Dialysis Transplantation, 2004
- Estimating the Number of Potential Organ Donors in the United StatesNew England Journal of Medicine, 2003
- Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomesTransplantation, 2002
- Effect of the Use or Nonuse of Long-Term Dialysis on the Subsequent Survival of Renal Transplants from Living DonorsNew England Journal of Medicine, 2001
- Effect of waiting time on renal transplant outcomeKidney International, 2000
- PRE-EMPTIVE TRANSPLANTS FOR PATIENTS WITH RENAL FAILURETransplantation, 2000
- Improved Graft Survival after Renal Transplantation in the United States, 1988 to 1996New England Journal of Medicine, 2000
- Comparison of Mortality in All Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric TransplantNew England Journal of Medicine, 1999
- Patient survival after renal transplantation: I. The impact of dialysis pre-transplantKidney International, 1998