TY - JOUR
T1 - Association between reperfusion renal allograft biopsy findings and transplant outcomes
AU - Mohan, Sumit
AU - Campenot, Eric
AU - Chiles, Mariana C.
AU - Santoriello, Dominick
AU - Bland, Eric
AU - Crew, R. John
AU - Rosenstiel, Paul
AU - Dube, Geoffrey
AU - Batal, Ibrahim
AU - Radhakrishnan, Jai
AU - Sandoval, P. Rodrigo
AU - Guarrera, James
AU - Stokes, M. Barry
AU - D'Agati, Vivette
AU - Cohen, David J.
AU - Ratner, Lloyd E.
AU - Markowitz, Glen
N1 - Funding Information:
This work was supported in part by the Laura and John Arnold Foundation, American Society of Transplant Surgeons and American Society of Transplantation’s Transplantation and Immunology Research Network, as well as the National Institute of Minority Health and Health Disparities (R01010290).
Publisher Copyright:
© 2017 by the American Society of Nephrology.
PY - 2017/10
Y1 - 2017/10
N2 - Biopsy findings at the time of procurement of deceased donor kidneys remain the most common reason cited for kidney discard. To determine the value of renal allograft histology in predicting outcomes, we evaluated the significance of histologic findings, read by experienced renal pathologists, in 975 postreperfusion biopsy specimens collected from 2005 to 2009 after living donor (n=427) or deceased donor (n=548) renal transplant.We evaluated specimens for the degree of glomerulosclerosis, interstitial fibrosis and tubular atrophy, and vascular disease; specimens with a score of 0 or 1 (scale, 0-3) for each parameter were considered optimal. Overall, 66.3% of living donor kidneys and 50.7% of deceased donor kidneys received an optimal histology score (P,0.001). Irrespective of donor status, suboptimal kidneys came from older donors with a higher incidence of diabetes mellitus, hypertension, and obesity and a higher mean kidney donor risk index (all P,0.001). Death-censored outcomes after transplant differed significantly between optimal and suboptimal kidneys only in the deceased donor transplants (P=0.02). Regardless of histologic classification, outcomes with deceased donor kidneys were inferior to outcomes with living donor kidneys. However, 73.2% of deceased donor kidneys with suboptimal histology remained functional at 5 years. Our findings suggest that histologic findings on postreperfusion biopsy associate with outcomes after deceased donor but not living donor renal transplants, thus donor death and organ preservation-related factors may be of greater prognostic importance.Discarding donated kidneys on the basis of histologic factors may be inappropriate and merits further study.
AB - Biopsy findings at the time of procurement of deceased donor kidneys remain the most common reason cited for kidney discard. To determine the value of renal allograft histology in predicting outcomes, we evaluated the significance of histologic findings, read by experienced renal pathologists, in 975 postreperfusion biopsy specimens collected from 2005 to 2009 after living donor (n=427) or deceased donor (n=548) renal transplant.We evaluated specimens for the degree of glomerulosclerosis, interstitial fibrosis and tubular atrophy, and vascular disease; specimens with a score of 0 or 1 (scale, 0-3) for each parameter were considered optimal. Overall, 66.3% of living donor kidneys and 50.7% of deceased donor kidneys received an optimal histology score (P,0.001). Irrespective of donor status, suboptimal kidneys came from older donors with a higher incidence of diabetes mellitus, hypertension, and obesity and a higher mean kidney donor risk index (all P,0.001). Death-censored outcomes after transplant differed significantly between optimal and suboptimal kidneys only in the deceased donor transplants (P=0.02). Regardless of histologic classification, outcomes with deceased donor kidneys were inferior to outcomes with living donor kidneys. However, 73.2% of deceased donor kidneys with suboptimal histology remained functional at 5 years. Our findings suggest that histologic findings on postreperfusion biopsy associate with outcomes after deceased donor but not living donor renal transplants, thus donor death and organ preservation-related factors may be of greater prognostic importance.Discarding donated kidneys on the basis of histologic factors may be inappropriate and merits further study.
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U2 - 10.1681/ASN.2016121330
DO - 10.1681/ASN.2016121330
M3 - Article
C2 - 28684646
AN - SCOPUS:85030452533
VL - 28
SP - 3109
EP - 3117
JO - Journal of the American Society of Nephrology : JASN
JF - Journal of the American Society of Nephrology : JASN
SN - 1046-6673
IS - 10
ER -