For patients with end stage renal disease (ESRD) transplantation is still the optimal treatment. Long term survival after kidney transplantation is dramatically better than dialysis and transplantation provides a sustainably higher quality of life. If successful, transplantation is more cost effective compared with long-term dialysis treatment in patients of all ages.
Suitable donor organs for transplantation
Unfortunately, there is a worldwide shortage of suitable donor organs for (kidney) transplantation which forces transplant teams to extend the donor criteria and to accept more older and higher risk organs retrieved from deceased donors. The use of these extended criteria donors has affected outcomes after transplantation due to an often suboptimal quality of the donor organ. As we will face more complex donors in the future with a reduced viability, the challenge in transplantation is to be able to use these donor sources, however, without compromising successful immediate function and long-term graft survival after transplantation. It is therefore imperative that the condition of every graft-to-be is optimised prior to or at the time of transplantation and that additional injury is minimised in order to achieve the best possible post-transplant function and avoid primary non function (PNF), delayed graft function (DGF), and rejection with chronic graft failure.