The number of cadaveric kidneys that are damaged when they are retrieved for transplantation is under-reported; however, most such organs can be successfully transplanted, according to a study based in the United Kingdom.
Stephen J. Wigmore, MD, and colleagues representing the Kidney Advisory Group reported in The Lancet on October 2 that a discrepancy exists in the United Kingdom "between kidney damage sustained and damage that is actually recorded by the retrieval team" (1999;354:1143-1146). Analyzing data on all cadaveric kidneys that were donated over five years in the United Kingdom, the investigators found that 1,726 of the 9,014 retrieved kidneys were reported as damaged; 1,630 of them were subsequently transplanted, and 96, or 1% of the total, were too damaged to be transplanted.
Damage was less likely to occur with kidneys from donors who were younger than 40, when kidneys were removed by a liver surgical team rather than a renal surgical team, and when the liver teams or centers that retrieved the kidneys undertook more than 50 such procedures each year. Kidneys reported as damaged at retrieval were more likely than other kidneys to be sent to another institution.
The findings indicate that "emphasis on the systematic evaluation and reporting of anatomical injury ought to be increased," Connie L. Davis and Christopher L. Marsh of the University of Washington in Seattle said in an accompanying commentary (1999;354;1136-1137).
In another report in the same issue of The Lancet, Peter J. Morris and coauthors found that, of various factors significantly associated with the outcome of cadaveric kidney transplantation in the United Kingdom, the best outcome occurred in the transplantation of kidneys with no HLA mismatches (1999;354;1147-1152). The authors said that, based on their work, a new allocation system for kidneys was introduced in the United Kingdom on July 1, 1998. During the first nine months of the new plan, the number of kidney transplants with no HLA mismatches doubled.
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