Biopsy of marginal donor kidneys: correlation of histologic findings with graft dysfunction
Randhawa, P.S.; Minervini, M.I.; Lombardero, M.; Duquesnoy, R.; Fung, J.; Shapiro, R.; Jordan, M.; Vivas, C.; Scantlebury, V.; Demetris, A.
Transplantation 69(7): 1352-1357
2000
ISSN/ISBN: 0041-1337 PMID: 10798753 Document Number: 518556
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.