Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Aug 26, 2019; 9(4): 62-80
Published online Aug 26, 2019. doi: 10.5500/wjt.v9.i4.62
Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best?
Maurizio Salvadori, Aris Tsalouchos
Maurizio Salvadori, Department of Transplantation Renal Unit, Careggi University Hospital, viale Pieraccini 18, Florence 50139, Italy
Aris Tsalouchos, Nephrology and Dialysis Unit, Saints Cosmas and Damian Hospital, Via Cesare Battisti, Pescia (PT) 2-51017, Italy
Author contributions: Salvadori M and Tsalouchos A contributed equally to the manuscript; Salvadori M designed the study, performed the last revision and provided answers to the reviewers; Tsalouchos A collected the data from literature; Salvadori M and Tsalouchos A analyzed the collected data and wrote the manuscript.
Conflict-of-interest statement: Maurizio Salvadori and Aris Tsalouchos do not have any conflict of interest in relation to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Maurizio Salvadori, MD, Professor, Department of Transplantation Renal Unit, Careggi University Hospital, viale Pieraccini 18, Florence 50139, Italy.
Telephone: +39-55-597151Fax: +39-55-597151
Received: March 6, 2019
Peer-review started: March 8, 2019
First decision: April 16, 2019
Revised: May 21, 2019
Accepted: July 30, 2019
Article in press: July 30, 2019
Published online: August 26, 2019

Organ shortage represents one of the major limitations to the development of kidney transplantation. To increase the donor pool and to answer the ever increasing kidney request, physicians are recurring to marginal kidneys as kidneys from older donors, from hypertensive or diabetic donors and from non-heart beating donors. These kidneys are known to have frequently a worse outcome in the recipients. To date major problem is to evaluate such kidneys in order to use or to discard them before transplantation. The use of such kidneys create other relevant question as whether to use them as single or dual transplant and to allocate them fairly according transplant programs. The pre-transplant histological evaluation, the clinical evaluation of the donor or both the criteria joined has been used and according the time each criterion prevailed over the others. Aim of this review has been to examine the advantages and the drawbacks of any criterion and how they have changed with time. To date any criterion has several limitations and several authors have argued for the development of new guidelines in the field of the kidney evaluation for transplantation. Several authors argue that the use of omic technologies should improve the organ evaluation and studies are ongoing to evaluate these technologies either in the donor urine or in the biopsies taken before transplantation.

Keywords: Kidney evaluation, Pre-transplant biopsies, Kidney donor evaluation, Kidney risk profile index, Omic technologies, Deceased donor score, Donor risk score

Core tip: With the extension of donor pool to high risk donors, the kidney pre-transplant evaluation became mandatory. Different criteria have been used, each of them with advantages and limitations. Probably the use of pre-transplant kidney biopsies in those kidneys coming from donors with the highest profile index seem to give the better results. These could be improved applying omic technologies either to donor urine or to pre-transplant biopsies. However the application of omic technologies is time consuming and not everywhere applicable. Several studies on these technologies are to date ongoing, but their results are yet not known.