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Brain death induced renal injury

Westendorp, Welmoet H; Leuvenink, Henri G; Ploeg, Rutger J

Current Opinion in Organ Transplantation: April 2011 - Volume 16 - Issue 2 - p 151–156
doi: 10.1097/MOT.0b013e328344a5dc
Organ preservation and procurement: Edited by Ernest van Heurn
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Purpose of review The considerable demand in kidney transplantation against a persisting organ donor shortage has forced most centers to nowadays accept of suboptimal donor kidneys.

Recent findings Despite the substantial increase in the past decade in kidney transplantation with grafts retrieved from living donors and after donation from deceased brain dead (DBD) and extended criteria donation (ECD) donors, the supply of donor kidneys still does not meet the actual numbers needed. Moreover, older and more marginal kidney donors following the physiologically abnormal state of brain death do function less well and have a shorter graft survival.

Summary In this review, we present an overview of the current knowledge of renal injury induced by pathophysiological effects of brain death and its relevance for renal transplant outcome.

The better insight in the role of brain death induced renal injury has clearly demonstrated its detrimental effect on outcome but, also, offers new opportunities for donor management and evaluation of new biomarkers to assess kidney graft quality in the brain dead donor. The option to intervene and selectively block or enhance a pathway as well as identify specific parameters for graft quality at time of organ retrieval in the deceased brain dead donor will ultimately benefit early function and long-term survival.

Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

Correspondence to Welmoet H. Westendorp, Department of Surgery, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands Tel: +31 503610531; fax: +31 503632793; e-mail: w.h.westendorp@chir.umcg.nl

© 2011 Lippincott Williams & Wilkins, Inc.