Biopsy of marginal donor kidneys: correlation of histologic findings with graft dysfunction

Transplantation. 2000 Apr 15;69(7):1352-7. doi: 10.1097/00007890-200004150-00024.

Abstract

Background: Kidney biopsies are being used to evaluate marginal donors, but rigorous statistical validation of this practice with multivariate analysis has not been performed.

Methods: To analyze histologic parameters in 78 donor biopsies for their ability to predict graft dysfunction, we used a proportional odds model that included both donor and recipient factors. Glomerulosclerosis was categorized into grades 0, 1, 2, and 3, corresponding to 0, 1-10%, 11-20%, and 21-30% global sclerosis, respectively. The degrees of interstitial fibrosis, tubular atrophy, arteriosclerosis, and arteriolar hyalinosis were graded from 0 to 3+, using definitions suggested by the Banff Schema of allograft pathology.

Results: Increasing donor age was associated with higher glomerulosclerosis, tubular atrophy, and arteriosclerosis. Kidneys with any degree of interstitial fibrosis were 2.6 times [odds ratio (OR)] more likely to experience a worse outcome at 6 months (P = 0.02). This association held up after correction for acute rejection (OR 2.5, P = 0.03) and high panel-reactive antibody (OR 3.4, P = 0.006), However, the OR was reduced to 1.9 (P = 0.15) after controlling for recipient age. With each increment in the grade of glomerulosclerosis, the odds for a worse outcome at 12 months increased to 2.3 (P = 0.005). The value for OR became 2.0 (P = 0.03) when controlling for recipient age (P = 0.01), 2.4 (P = 0.005), when controlling for acute rejection, and 2.3 (P = 0.006) when controlling for high panel-reactive antibody.

Conclusions: Histopathological parameters present in donor biopsies can independently predict post-transplant graft function. Implications for the pool of donor organs available for transplantation are discussed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • African Continental Ancestry Group / genetics
  • Aged
  • Aging / physiology
  • Biopsy
  • Child
  • Genetic Predisposition to Disease
  • Humans
  • Kidney / pathology*
  • Kidney / physiopathology*
  • Kidney Diseases / genetics
  • Kidney Diseases / pathology
  • Kidney Diseases / physiopathology
  • Kidney Transplantation*
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Postoperative Period
  • Tissue Donors*
  • Treatment Outcome