The increased demand for kidney transplantation and organ shortage resulted in the increased use of kidneys from suboptimal donors. Therefore, identification of kidneys that can be accepted without significantly compromising the outcome of allograft or recipient has become critical. A robust assessment of organ quality is of particular importance especially in kidneys from elderly donors in whom morphological and functional changes associated with aging and diseases are obvious. A number of predictive tools have been developed to help with evaluating the suitability of a deceased-donor kidney for transplantation. Among those, Kidney Donor Profile Index and zero hour graft biopsy in elderly donors have been already implemented in several transplant programs. This review captures the recent literature on this subject and discusses approaches for evaluating the quality of kidney grafts from elderly donors.
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