Results of kidney transplantation from high-terminal creatinine donors and the role of time-zero biopsy

Transplant Proc. 2010 Nov;42(9):3382-6. doi: 10.1016/j.transproceed.2010.08.053.


Background: Deceased-donor kidney transplantation (DDKT) from high-terminal creatinine donors is associated with lower graft survival. These kidneys may be considered for discarding, worsening the organ shortage crisis. Using time-zero biopsy for histologic evaluation of these kidneys, we identified those organs eligible for transplantation, seeking to achieve better graft utility with comparable outcomes.

Methods: From April 2004 to April 2008, 55 patients underwent DDKT. A time-zero biopsy was used to examine glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriolar narrowing. A scoring system was used to determine a discard.

Results: Twenty-five patients received DDKT from donors whose terminal creatinine levels were >2.0 mg/dL (high terminal creatinine, HTC group) and 30 from donors whose terminal creatinine levels were <2.0 mg/dL (low terminal creatinine, LTC group). Patients who accepted kidneys from HTC donors had shorter waiting times (P = .011) but a higher incidence of delayed graft function after transplantation (P < .001). Nonetheless, 5-year graft survival rates were similar between the two groups.

Conclusions: With a time-zero biopsy for histologic evaluation, kidneys recovered from high-terminal creatinine donors can be transplanted to overcome the organ shortage while achieving reasonable graft survival.

MeSH terms

  • Adult
  • Biomarkers / blood
  • Biopsy
  • Creatinine / blood*
  • Delayed Graft Function / etiology
  • Donor Selection*
  • Graft Rejection / etiology
  • Graft Survival*
  • Humans
  • Kidney Transplantation* / adverse effects
  • Kidney* / pathology
  • Kidney* / physiopathology
  • Kidney* / surgery
  • Middle Aged
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Taiwan
  • Time Factors
  • Tissue Donors / supply & distribution*
  • Treatment Outcome
  • Waiting Lists
  • Young Adult


  • Biomarkers
  • Creatinine