Based on our findings, we propose that acceptance criteria for marginal donor kidneys need to be widened.

Objective: We conducted this study to determine whether it is justifiable for transplant centers to reject cadaveric donor organs based on marginal organ quality. There is a growing discrepancy between the demand for renal transplants and the number of transplants conducted. For the many patients on the renal transplant waiting list, this translates into increased dialysis-associated morbidity, mortality and a reduced quality of life. Patients and Methods: In our retrospective analysis, we focused on deceased donor kidneys that had been rejected in other transplant centers because of poor organ quality (111 patients) and then accepted for transplantation at our center, compared with a control group consisting of 343 patients. Results: Cold ischemia time was statistically significantly shorter in the control group (11 vs. 12.5 h, p = 0.005). Also, delayed graft function occurred significantly (p = 0.004) more often in the study group (45.9-30.3%). Parameters regarding perioperative data and recipient outcome did not show significant differences and except for 2 time points at 1 week and 3 months, graft function did not differ either. Conclusions: We propose that acceptance criteria for marginal donor kidneys should be expanded. Centers should reconsider their acceptance criteria in the light of these findings as the results of these transplantations may even be much better if the delay due to reallocation and retransport can be spared.

Immunosuppressive treatment increases the risk of infection and malignancy in organ transplant recipients. We report on a 42-year-old male renal transplant recipient who lost his first graft after reduction of immunosuppressive treatment due to Kaposi sarcoma and who successfully underwent a second renal transplant 10 years later. The patient’s current treatment consists of low-dose prednisone, and the two antiproliferative immunosuppressants mycophenolate mofetil and rapamycin. 4.5 years after his second transplant, the serum creatinine is 1 mg/dl and the patient has no signs of recurrent disease.

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