Living donor kidney transplantation in the United States--looking back, looking forward.
ABSTRACT There is a desperate need for kidney donors. Twenty-five years ago, we urged more widespread acceptance of unrelated living donors for kidney transplantation. Since then, 2 of us have donated a kidney to an unrelated recipient. In our view, the major challenges for living donor transplantation today are to improve access to this extraordinary gift of life and ensure its safety. Our perspective is that altruism is the motivation for most living kidney donors and the decision to donate represents a shared responsibility among the donor, the donor's physician, and the team of professionals at the transplant center. Thus, sound knowledge of the benefits and risks to donors and recipients is required for informed decisions, and all parties share in the responsibility for the outcomes after living kidney donation. We encourage our colleagues and agencies within the US Department of Health and Human Services to accept the responsibility to do their utmost to provide access to this life-enhancing procedure and systematically evaluate the safety of kidney donation as it evolves to meet the needs of more of our patients.
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ABSTRACT: Cold storage of kidneys before transplantation is problematic because of limited survival time of the allografts. In this study, Zinc-N-acetylcysteine (ZnNAC) was shown to be a potent endonuclease inhibitor and antioxidant, and it was tested as a potential additive to a cold storage solution for kidney preservation. Exposure of normal rat kidney NRK-52E cells to ZnNAC resulted in zinc delivery to the cells determined by TFL-Zn fluorophore and partial protection of the cells against injury by cold storage in the University of Wisconsin solution (UWS) as measured by propidium iodide assay. Ex vivo, rat kidneys demonstrated time- and temperature-dependent DNA fragmentation assessed by TUNEL assay, indicating irreversible cell death. The DNA fragmentation was faster in medulla than in cortex, and tubules were affected more than glomeruli. Perfusion of rat kidneys with cold ZnNAC solution in UWS significantly inhibited cell death both in the cortex and medulla at concentrations 0.3-30 mM as compared to UWS alone, with the maximum effect at 1-10 mM ZnNAC. Cold storage of the kidney significantly increased quantities of cleaved caspase-3 and endonuclease G in the tissue which was abolished by 10 mM ZnNAC indicating its ability to suppress both caspase-dependent and -independent cell death. Therefore, supplementation of UWS with ZnNAC can decrease DNA fragmentation and protect kidney allograft from cell death due to cold storage.AJP Renal Physiology 07/2013; · 4.42 Impact Factor
- American Journal of Kidney Diseases 05/2014; · 5.29 Impact Factor
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ABSTRACT: Worldwide shortage of standard brain dead donors (DBD) has revived the use of kidneys donated after circulatory death (DCD). We reviewed the Belgian DCD kidney transplant (KT) experience since its reintroduction in 2000. Risk factors for delayed graft function (DGF) were identiﬁed using multivariate analysis. Five-year patient/graft survival was assessed using Kaplan–Meier curves. The evolution of the kidney donor type and the impact of DCDs on the total KT activity in Belgium were compared with the Netherlands. Between 2000 and 2009, 287 DCD KT were performed. Primary nonfunction occurred in 1% and DGF in 31%. Five-year patient and death-censored graft survival were 93% and 95%, respectively. In multivariate analysis, cold storage (versus machine perfusion), cold ischemic time, and histidine-tryptophan-ketoglutarate solution were independent risk factors for the development of DGF. Despite an increased number of DCD donations and transplantations, the total number of deceased KT did not increase signiﬁcantly. This could suggest a shift from DBDs to DCDs. To increase KT activity, Belgium should further expand con- trolled DCD programs while simultaneously improve the identiﬁcation of all potential DBDs and avoid their referral for donation as DCDs before brain death occurs. Furthermore, living donation remains underused.Transplant International 06/2012; · 3.16 Impact Factor