Prognostic utility of preimplantation kidney biopsy from deceased older donors in first year post-transplant renal function

Abstract

Background: Preimplantation renal biopsy provides potentially valuable information about post-transplant renal function. Objective: To assess the prognostic value of preimplantation kidney biopsy from older donors in determining 1-year post-transplant estimated glomerular filtration rate MDRD-4 (eGFR). Methods: We evaluated a cohort of 124 renal transplant recipients from deceased donors ≥60 years old, performed at our centre between March 2008 and May 2012. Biopsies were assessed by applying the score proposed by O’Valle et al. The overall score was stratified into 3 levels: 0–3, 4–5 and 6–8 points. Kidneys scoring >8 points were discarded. A total of 77% of the donors were ≥70 years. Results: One year post-transplant, mean eGFR (SD) was lower in transplant recipients with 6–8 points (38.5 [14.1] ml/min/1.73 m2) than in the group scoring 4–5 points (46.3 [15.7] [p = 0.03]) and the group scoring 0–3 (49.6 [12.5] [p = 0.04]). Seven patients (19%) had eGFR <30 ml/min/1.73 m2 1 year post-transplant in group 6–8 vs 8 (14%) in group 4–5 and none in group 0–3. In the logistic regression, OR (95% IC), to determine patients with 1-year post-transplant eGFR (<30 ml/min/1.73 m2), delayed graft function (6.3 [1.9–21.3]) and acute rejection (5.8 [1.1–31]), were significant. The adjusted OR of biopsy score group 6–8 vs 0–5, was 2.2 (0.7–7.3). Conclusions: Allografts with higher pathologic score in preimplantation renal biopsy were associated with a worse 1-year post-transplant eGFR. Delayed graft function and acute rejection were significant risk factors for 1-year post-transplant low eGFR.

Keywords

• Older deceased donor
• Expanded criteria donor
• Preimplantation kidney biopsy
• Kidney transplantation
• Glomerular filtration rate