Impact of the pre-transplant histological score on 3-year graft outcomes of kidneys from marginal donors: a single-centre study

• Published in: Nephrology, dialysis, transplantation Vol. 28; no. 10; pp. 2637 - 2644
• Main Authors: Carta, Paolo, Zanazzi, Maria, Caroti, Leonardo, Buti, Elisa, Mjeshtri, Anduela, Di Maria, Lorenzo, Raspollini, Maria Rosaria, Minetti, Enrico Eugenio
• Format: Journal Article
• Language: English
• Published: England 01.10.2013
• Subjects: Aged; Cadaver; Cohort Studies; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Rejection - mortality; Graft Survival - physiology; Humans; Kidney - pathology; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Kidney Function Tests; Kidney Transplantation - mortality; Male; Prognosis; Retrospective Studies; Risk Factors; Survival Rate; Tissue and Organ Procurement; Tissue Donors; pre transplant histological score; extended-criteria donor; renal transplantation
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gft292

The reliability of kidney biopsy as the sole means for assessing kidneys from extended-criteria donors (ECDs) to be allocated to single or dual transplantation is still a matter of debate. We compared retrospectively 3 years graft survival and renal function in 44 recipients of a single kidney graft from a marginal donor with good renal function and a Karpinski histological score of ≤ 3 and 56 recipients of a single transplant with a Karpinski score of 4 or 5. The donors' and recipients' characteristics were compared by means of Wilcoxon's rank-sum test and Fisher's exact test, and survival was analysed using the log-rank test and Cox regression survival analysis. The donors with the worse histological scores were slightly younger (68.0 ± 4.74 versus 71.3 ± 4.6 years, P < 0.01) and had a higher glomerular filtration rate (85.8 ± 28.2 versus 76.3 ± 26.53 mL/min, P = 0.013), but there was no difference in serum creatinine levels (0.83 ± 0.24 versus 0.85 ± 0.30 mg/dL, P = 0.381). Three years after transplantation, there was no difference between the two groups in terms of recipient serum creatinine levels (1.94 ± 0.69 versus 1.74 ± 0.49 mg/dL, P = 0.134), estimated glomerular filtration rate (eGFR, 45.6 ± 21.1 versus 51.7 ± 22.0 mL/min, P = 0.331) or the rates of graft loss (27.3 versus 35.7%, P = 0.47), delayed graft function or acute rejection. In our experience, provided the donor has a normal renal function, a difference in the pre-transplant histological score of kidneys from marginal cadaveric donors do not have a significant influence on the outcome 3 years after transplantation. Our findings might represent a basis for designing a randomized controlled trial of using a higher histological score threshold for the DKT allocation of grafts from ECDs with a normal renal function.