| Popis: |
Successful efforts to enhance the supply of organs available for transplantation have involved expansion of the donor pool to include marginal donors. There is now considerable experience to support the policy that no expanded criteria donor kidneys should be discarded, providing preimplantation kidney biopsy is acceptable; based on biopsy findings, up to 35% and 44% of kidneys from deceased donors older than 60 years may be adequate for a single or dual transplant, respectively. Using these kidneys should increase the current organ supply by another 25%–30%. Nevertheless, dual kidney transplantation has not gained acceptance worldwide, representing only about 2% of transplanted kidneys in the United States. As a result of the increased perioperative risk, many recipients with cardiovascular disease are not deemed suitable for dual transplantation. Moreover, dual kidney transplantation implies the occupation of two iliac fossae, which might be an issue in younger recipients with longer life expectancy. However, when dual transplantation is performed in selected patients, the risk of perioperative and surgical complications is low, and the outcomes are significantly better than those of older grafts transplanted without a biopsy evaluation. |
