Open AccessCorrelation of histologic findings on preimplant biopsy with kidney graft survival
Author(s) -
Kayler Liise K.,
Mohanka Ravi,
Basu Amit,
Shapiro Ron,
Randhawa Parmjeet S.
Publication year - 2008
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/j.1432-2277.2008.00681.x
Subject(s) - medicine , multivariate analysis , univariate analysis , nephrology , arteriolosclerosis , renal function , surgery , glomerulosclerosis , kidney , biopsy , fibrosis , kidney disease , urology , pathology , gastroenterology , disease , proteinuria
Summary Kidney biopsies are being used to evaluate marginal deceased donor organs, but, the literature on the utility of this practice remains conflicting. We re‐examined this issue by performing a multivariate analysis of 597 kidney transplant recipients. The presence of moderate arteriosclerosis and/or moderate arteriolosclerosis (MA), defined as ≥25% luminal compromise, was a significant predictor of graft outcome in standard criteria donors (multivariate, P = 0.01) and in expanded criteria donors (ECD) as defined by UNOS criteria (univariate P = 0.02). One‐, 3‐, and 5‐year overall allograft survival with MA was 71%, 58%, and 40%, respectively. Increasing degrees of glomerulosclerosis (GS) were associated with earlier graft failure on univariate ( P = 0.03) but not multivariate analysis ( P = 0.36). GS > 20% and interstitial fibrosis >25% had a low frequency in the material reviewed, likely reflecting our organ utilization practices, and did not have a demonstrable effect on graft outcome. Clinical parameters independently associated with worse graft function were ECD status ( P < 0.05), retransplantation ( P = 0.004), recipient age ( P < 0.05), and delayed graft function ( P < 0.0001). Donor vascular disease is an independent risk factor for suboptimal graft survival. Great caution should be exercised in the decision to transplant kidneys with moderate arterial and/or arteriolar luminal narrowing.