• Assessment of donors with sub-optimal kidney function/structure. Nephrology 2005 Oct;10(S4):S120-4.



• Assessment of donors with sub-optimal kidney function/structure. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Jul. 12 p. [20 references]

This is the current release of the guideline.

Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.

Guidelines

No recommendations possible based on Level I or II evidence

Suggestions for Clinical Care

(Suggestions are based on Level III and IV sources)

• Procurement of renal allografts from extended criteria donors should continue to be actively pursued.
• Assessment of such potential renal allografts should take into account donor factors, issues at the time of procurement, plus the result of a pre-implantation renal allograft biopsy.
• Use of extended criteria donors' renal allografts should only be in the setting of recipient informed consent, weighing up the risks versus benefits.
• The decision to accept a deceased donor as suitable for renal donation is the responsibility of both nephrologists and renal surgeons experienced in renal transplantation.
• The approach to a deceased organ donor should be to consider age, renal function and renal structure, other co-morbidities, to categorise the kidneys into optimal or marginal.
• Extended criteria donor (ECD) kidneys are those which after transplantation, lead to a significantly worse outcome as defined by poor graft survival or inferior renal function.
• The predominant features of ECD kidneys are reduced donor renal function and/or structural abnormality.
• These kidneys are usually procured from donors with cumulative effects of the following characteristics: age > 55 years, pre-existing hypertension, diabetes mellitus, history of vascular disease, elevated or rising serum creatinine, history of systemic disease or medications known to affect the kidneys, and non-heart-beating donor.
• Assessment of ECD kidneys should include surgical assessment at procurement with particular note of renal size, presence of scars/masses, vasculature, and organ perfusion.
• Assessment of renal function is by estimated creatinine clearance using the best admission serum creatinine.
• Histological assessment of procurement needle biopsy is by taking particular note of percentage glomerulosclerosis, arteriolar disease and interstitial fibrosis. Any identified lesion should also be biopsied.
• Assessment of ECD kidneys should determine whether the kidney is acceptable for single transplantation. If not, a decision should be made to determine whether the kidneys are suitable for double transplantation. Double transplantation should not be considered unless the donor creatinine clearance is < 80 mL/min, and the percentage glomerulosclerosis is 20% to 40%, or severe vascular disease is present. Organs not transplanted should be managed according to the wishes of the family and or the requirements of the coroner.

Allocation Issues

• Attention should be made to minimising the cold ischaemic time of ECD kidneys.
• Non-heart-beating donor kidneys and dual transplants should be allocated within the state of donation.
• There is conflicting evidence on the value of allocating ECD kidneys to either younger or older recipients.
• Education regarding the possibility of transplantation with an ECD or dual transplant including the risks and benefits of the procedure should be a prerequisite of entry onto the transplant waiting list. Recipients of ECD or dual kidneys must give specific informed consent prior to transplantation.
• Kidneys from paediatric donors < 15 kg and/or < 5 years should be considered for en-bloc transplantation.
• Beware of inotropes and either microscopic haematuria (dysmorphic red cells) or proteinuria in the donor.
• Radiological means of assessing donor kidneys prior to procurement may be of limited benefit.
• Backtable biopsy preferably involves a needle biopsy (not wedge biopsy) through the upper pole cortex.

Definitions:

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

• Assessment of donors with sub-optimal kidney function/structure. Nephrology 2005 Oct;10(S4):S120-4.



• Assessment of donors with sub-optimal kidney function/structure. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Jul. 12 p. [20 references]

Not applicable: The guideline was not adapted from another source.

2005 Oct

Caring for Australasians with Renal Impairment - Disease Specific Society

Industry-sponsored funding administered through Kidney Health Australia

Not stated

Authors: David Harris, Convenor (Westmead, New South Wales); Merlin Thomas (Prahran, Victoria); David Johnson (Woolloongabba, Queensland); Kathy Nicholls (Parkville, Victoria); Adrian Gillin (Camperdown, New South Wales)

All guideline writers are required to fill out a declaration of conflict of interest.

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on April 22, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.