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首页> 美国卫生研究院文献>Clinical Kidney Journal >To discard or not to discard: transplantation and the art of scoring
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To discard or not to discard: transplantation and the art of scoring

机译：丢弃还是不丢弃：移植和评分技术

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摘要

The growing gap between inadequate supply and constantly high demand for kidney transplantation observed in the last two decades led to exploring the possibility of using organs from older donors with an increasing number of comorbidities. The main issue in this scenario is to identify transplantable organs and to allocate them to the most suitable recipients. A great number of clinical investigations proposed several acceptance/allocation criteria to reduce the discard rate of these kidneys and to improve their outcome, including histological features at the time of transplant. Despite the widespread use of several histological scoring systems, there is no consensus on their value in predicting allograft survival and there is established evidence that histological analysis is the most common reason to discard expanded criteria donor kidneys. To overcome this issue, a clinical scoring system, the Kidney Donor Profile Index (KDPI), was developed on the basis of easily accessible donor features. The KDPI score, adopted in the new US allocation procedure, has good reproducibility but presents several limitations, as suggested also in this issue of Clinical Kidney Journal. This observation should stimulate the search for novel scores combining clinical, histological and molecular features in an attempt to improve the decision process.
机译：在过去的二十年中，肾脏移植的供不应求和持续高需求之间的差距日益扩大，这导致人们探索使用合并症越来越多的老年供体器官的可能性。这种情况下的主要问题是识别可移植器官并将其分配给最合适的接受者。大量的临床研究提出了几种接受/分配标准，以降低这些肾脏的丢弃率并改善其结局，包括移植时的组织学特征。尽管广泛使用了几种组织学评分系统，但它们在预测同种异体移植存活率方面的价值尚无共识，并且已有证据表明组织学分析是丢弃扩大标准供体肾脏的最常见原因。为了克服这个问题，在易于获得的供体特征的基础上开发了一种临床评分系统，即肾脏供体概况指数（KDPI）。在新的美国分配程序中采用的KDPI评分具有良好的可重复性，但存在一些局限性，正如本期《临床肾脏杂志》所建议的那样。该观察结果应激发寻求结合临床，组织学和分子特征的新颖评分的尝试，以改善决策过程。

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