Marginal kidney transplantation the road less traveledSharma, Neeraj; Mahajan, Arnav; Qazi, Yasir A.Current Opinion in Organ Transplantation: February 2019 - Volume 24 - Issue 1 - p 92–96 doi: 10.1097/MOT.0000000000000603 RENAL TRANSPLANT: Edited by Yasir A. Qazi Buy SDC Abstract Author InformationAuthors Article MetricsMetrics Purpose of review Kidney transplantation indisputably confers a significant survival advantage and a better quality of life compared with dialysis, however, because of the increasing demand for kidney transplantation many patients continue to wait prolonged periods for kidney transplantation. The first step to alleviate the shortage is to reduce the discard rate by utilizing more marginal kidneys. This review studied the recent literature on marginal kidney transplantation. Recent findings More than 60% of high-KDPI kidneys are discarded. Despite the increase in posttransplant costs, use of high KDPI transplants suggests a gain in survival years, thus making marginal kidney transplant cost effective. Furthermore, recent evidence suggests that marginal kidney transplantation shows a survival benefit compared with remaining in the waitlist and minimizes the kidney discard rate. Summary Transplantation with marginal kidneys provides a survival benefit over dialysis or waiting for a low-KDPI kidney. As a result, clinicians should strongly consider transplantation of marginal kidneys as opposed to waiting for a better offer. University of Southern California – Keck School of Medicine, Los Angeles, California, USA Correspondence to Neeraj Sharma, USC Transplant Institute, 1510 San Pablo Street Suite 200, Los Angeles, CA 90033, USA. Tel: +1 323 409 7307; fax: +1 323 442 8511; e-mail: firstname.lastname@example.org Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.