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viernes, 10 de marzo de 2017

Transplante con riñon marginal / Transplantation with marginal kidney

Marzo 9, 2017. No. 2623

¿Es un abuelo de 87 años de edad demasiado marginal para ser un donante de riñón? La visión de los anestesiólogos

Is an 87-Year-Old Grandfather Too Marginal for Being a Kidney Donor? The View of Anesthesiologists.

Kesimci E1, Erkilic E1, Kilinc I2, Kilic M3.

J Clin Med Res. 2016 Sep;8(9):680-2. doi: 10.14740/jocmr2629w. Epub 2016 Jul 30.

Abstract

Living kidney donation has been accepted increasingly as a result of growth in the number of end-stage renal disease patients awaiting organ. In this aspect using grafts from marginal donors such as with advanced age is increasing in worldwide practice and also in Turkey. Therefore, anesthetic management of donors is particularly important. We herein report the anesthetic management of an 87-year-old grandfather donating his kidney to her granddaughter and review the current anesthetic strategies in a geriatric patient.

KEYWORDS: Anesthesia; Elderly donor; Geriatrics; Kidney; Transplantation

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¿Cuándo es Justificable el Trasplante con un "Riñón Marginal"?

When is Transplantation with a "Marginal Kidney" Justifiable?

Rouchi AH1, Mahdavi-Mazdeh M1.

Ann Transplant. 2016 Jul 26;21:463-8.

Abstract

The ability of kidney transplantation to improve quality of life has made this therapeutic modality the treatment of choice among renal replacement therapies; however, the continuing organ shortage has forced the use of marginal kidneys as a supplementary source of allografts. It has been repeatedly suggested that failed kidney transplant recipients have greater morbidity and mortality compared with dialysis patients with no renal transplant history. Achieving an optimal balance between the advantages of kidney transplant and disadvantages of allografts with marginal quality is a topic of controversy in transplant medicine. The major and potentially life-threatening complications of immunosuppressive therapies and shorter lifespan following graft failure necessitate a reappraisal of kidney transplant programs from expanded-criteria deceased donors, which can neither necessarily give dialysis patients a better quality of life nor a significant survival benefit, especially in settings with additional diminished graft survival due to HLA-mismatch. It should be offered just to those with short life expectancy and with HLA-matching. The last item is very important in countries without mandatory HLA-matching protocols for kidney transplantation programs.

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