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A Simple Clinico‐Histopathological Composite Scoring System Is Highly Predictive of Graft Outcomes in Marginal Donors
Author(s) -
Anglicheau D.,
Loupy A.,
Lefaucheur C.,
Pessione F.,
Létourneau I.,
Côté I.,
Gaha K.,
Noël L.H.,
Patey N.,
Droz D.,
Martinez F.,
Zuber J.,
Glotz D.,
Thervet E.,
Legendre C.
Publication year - 2008
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2008.02394.x
Subject(s) - medicine , renal function , creatinine , urology , univariate analysis , biopsy , predictive value , multivariate analysis , glomerulosclerosis , predictive value of tests , surgery , gastroenterology , kidney , proteinuria
The predictive value of pre‐implantation biopsies versus clinical scores has not been studied extensively in marginal donors. Pre‐implantation biopsies were performed in 313 kidneys from donors that were ≥ 50 years of age (training set, n = 191; validation set, n = 122). The value of the donor clinical parameters and histological results in predicting 1‐year estimated glomerular filtration rate (eGFR) <25 mL/min/1.73 m 2 was retrospectively evaluated. In multivariate analysis, the only clinical parameters associated with low eGFR were donor hypertension and a serum creatinine level ≥150 μmol/L before organ recovery. Clinical scores (Nyberg and Pessione) were not significantly associated with graft function. Regarding histological parameters, univariate analysis showed that glomerulosclerosis (GS) (p = 0.02), arteriolar hyalinosis (p = 0.03) and the Pirani (p = 0.02) and chronic allograft damage index (CADI) (p = 0.04) histological scores were associated with low eGFR. The highest performance in predicting low eGFR was achieved using a composite score that included donor serum creatinine (≥150 μmol/L or <150 μmol/L), donor hypertension and GS (≥10% or <10%). The validation set confirmed the critical importance of taking into account biopsy and clinical parameters during marginal donor evaluation. In conclusion, clinical scores are weak predictors of graft outcomes with marginal donors. Instead, a simple and convenient composite score strongly predicts graft function and survival and may facilitate optimal allocation of marginal donors.