A strategy For Reducing the Kidney Allograft Discard Rate
The national discard rate has ranged from 12% to 18% over the years. Approximately 50% of the criteria for discard have been based upon kidney biopsies; although there are reports that when the kidneys have been transplanted glomerulosclerosis does not correlate well with 1-year graft survival, while pretransplant functional evaluations such as CrCl do. The development of novel biomarkers to reduce the rate suggested ...more »
The national discard rate has ranged from 12% to 18% over the years. Approximately 50% of the criteria for discard have been based upon kidney biopsies; although there are reports that when the kidneys have been transplanted glomerulosclerosis does not correlate well with 1-year graft survival, while pretransplant functional evaluations such as CrCl do. The development of novel biomarkers to reduce the rate suggested by Dr. Parikh is important. Another approach would be to develop prospective ex vivo evaluation of kidneys procured for transplantation but later discarded according to standard institutional criteria. This would necessitate transferring the hypothermically stored discarded kidneys to a near-normothermic perfusion. Quantifiable parameters such as restored metabolism, vascular dynamics, potential for regeneration and function could be used to develop a calculated index that would provide an objective basis for lowering the discard rate.
« less full details »