ABSTRACT
The lack of organ donors is a major obstacle against the application of liver transplantation.Recently,how to expand the source of liver donors has become a focus of transplantation research.The use of marginal donor may help solve current dilemma between the increasing waiting recipients and the relatively few donors.However,marginal donors always comes with elevated risk of primary nonfunction,initial poor function,delayed graft function loss and infection.Research on risk factors and complication preventing strategies of marginal donor transplantation is important in improving our understanding of liver transplantation.In the present article,we summarized recent progress in the research of marginal donors.And based on the experience from our center,we believe that the use of marginal donors in liver transplantation may help improve the situation of donor shortage,and isehemia-reperfusion injury remains the core topic of marginal donor transplantation and represents the direction of future study.
ABSTRACT
Objective To analyze the clinical effectiveness of using marginal donor kidney in living kidney transplant. Methods From November 2005 to June 2011,274 cases of living kidney transplant were performed in the First Affiliated Hospital of Zhengzhou University.The cases were divided into the marginal donors group ( Donor ages over 60 years old,suboptimal renal anatomy or physiology) of 66 cases and standard donors group of 208 cases.The clinical data were retrospectively analyzed.The criteria of marginal donors were as follows:36 cases of donors with age over 60 yrs (6 cases with renal cysts and 1 case with renal calculus),22 cases of renal cysts ( with diameter range from 4 mm to 40 mm ),4 cases of renal calculus (with diameter range from 3 mm to 6 mm),4 cases of low GFR (under 35 ml/min.The mean recipients' serum creatinine before surgery and after surgery on day 3,day 7,month 1,month 3,month 6,month 12,related complications,the rate of acute rejection and delayed graft function,1 year,3 year recipient/kidney survival were compared between the 2 groups,respectively. Results The serum creatinine levels in the marginal donor group and standard donor group were (242.7 ± 132.2 vs 185.6 ± 148.4) and ( 156.7 ±86.8 vs 122.2 ± 136.8 ) on day 3,day 7 respectively ( P ＜ 0.05 ).Nevertheless,there were no significant differences between the 2 groups in recipients' serum creatinines before surgery and after surgery on month 1,month 3,month 6,month 12,peri-operative complications,the rate of acute rejection and delayed graft function,1 year,3 year recipient/kidney survival (P ＞ 0.05). Conclusions Healthy old donors and donors with renal cyst (the diameter of renal cysts under 40mm) should not be the barriers to organ donation.To those living donors with low GFR,we should consider of donor age,donor/recipient body weight,donor/recipient body surface area and whether we could deal with the problem by surgical operation.Donor with renal calculus should be carefully evaluated.
ABSTRACT
Este artigo tem como objetivo revisar a nomenclatura, a classificação e a utilização dos doadores limítrofes no transplante de fígado. O rápido crescimento do número de transplantes hepáticos tem sido desacelerado por falta de doadores, e existe aumento de doentes em listas de espera. A escassez de órgãos tem levado muitos programas de transplante a estender seus critérios de aceitação de doadores. Esses doadores limítrofes ou marginais provêem imediata expansão do número de órgãos para transplante. Tal desequilíbrio entre doador e disponibilidade de órgãos em cotejo com o número de receptores é um problema internacional. O uso de doadores marginais é estratégia sobremodo usada em bem qualificadas unidades de transplantes. Este artigo tem como objetivo revisar a nomenclatura, a classificação e a utilização dos doadores limítrofes no transplante de fígado. O aumento do número de transplante de fígado acima de 20% foi obtido nos últimos anos graças à crescente aceitação e utilização dos enxertos limítrofes também conhecidos como marginais. Assim, a utilização sistemática de enxertos limítrofes maximiza o uso de doadores, aumenta o acesso ao transplante de fígado e reduz a mortalidade na lista de espera e apresenta resultados satisfatórios em pacientes selecionados.
The rapid growth of the number of liver transplantation has been curtailed by the lack of donors and has an increase of patients on the waiting list. This lack of organs has led a number of transplantation programs to expand its criteria of donors acceptance. These borderline or marginal donors provide immediate expansion of the number of available organs for transplantation. This imbalance between organ donors availability and the number of recipients is an international problem. The use of marginal donor is a strategy used mostly in large liver transplantation units. This paper reports a review of nomenclature, classification and utilization of borderline donors for liver transplantations. The number of liver transplantation rose over 20% in the last past years due to the growing acceptance and utilization of borderline transplanted organs known as marginal grafts. Thus, systematical marginal grafts utilization maximizes. The donor use, increases access to liver transplantation and reduces waiting-list mortality, still provides satisfactory outcomes to selected recipients.
ABSTRACT
Objective To analyze the influence of donating kidney of marginal donors on the early prognosis of living-related kidney transplant recipients.Methods Sixty-six cases of living-re-lated kidney transplant patients between February 2004 and September 2007 were divided into the marginal donors group(28 cases)and non-marginal donors group(38 cases).Serum creatinine before and after surgery,creatinine clearance after surgery and perioperation complications were compared respectivelv between the 2 groups.Results The serum creatinine levels in the marginal donors group and non-marginal donors group were 154,131,127μmol/L and 132,117,118 ttmol/L on 7th day,1st month and 3rd month after transplantation respectively,and there were no significant differences between the 2 groups(P＞0.05).The serum creatinine level in parent-child donating kidney of the 2 groups Was 160,131,126μmol/L and 132,129,126μtmol/L on 7th day,1st month and 3rd month after transplantation respectively,and there were no significant differences too(P＞0.05).There was no difference in the rate of perioperation complications and creatinine clearance after kidney transplantation between the 2 groups.Conclusions The early prognosis of marginal donors'recipients is ideal.The marginal donors could be selected as the living-related kidney transplant donors,especially between parent and child,as long as they are evaluated according to stricter criteria.But the long-term prognosis of the recipients should be further observed.