Kidney transplantationIschemia-reperfusion injuryFunctional and Morphological Changes in Kidneys From Marginal Donors

Despite the increased number of cadaver donors and overall organ transplantations, we have observed a dramatic increase in the waiting list. We evaluated transplantations performed using marginal (n = 63) and “ideal” or optimal donors (n = 86). Donor and recipient functional and histopathological data were studied at 1 and 5 years after transplantation. Among the marginal donor group, we investigated whether the age or pre-existent hypertension in the donor showed a strong impact on the functional deterioration of the grafts. Twenty-three graftectomies were performed in marginal, and 39 in ideal recipients (P = .002). Evaluating graft function, at 5 years, we observed the serum creatinine level (P = .0001) and the estimated glomerular filtration rate (P = .003) are significantly different between the two groups. At this time there was a significant difference in the serum creatinine level of patients who were older than the age of 55 years compared with those who showed hypertension (P = .0003). Evaluating morphological changes in the kidneys, acute rejection episodes (P = .0004) and interstitial fibrosis/tubular atrophy (P = .002) were significantly greater among the marginal versus the ideal groups. At 1 year after kidney transplantation, despite no significant difference regarding renal function, they were significant in the histology of marginal versus ideal donor kidneys.