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. 2020 May 14;9(5):1469.
doi: 10.3390/jcm9051469.

Degree of Glomerulosclerosis in Procurement Kidney Biopsies from Marginal Donor Kidneys and Their Implications in Predicting Graft Outcomes

Wisit Cheungpasitporn  1 , Charat Thongprayoon  2 , Pradeep K Vaitla  1 , Api Chewcharat  2 , Panupong Hansrivijit  3 , Felicitas L Koller  4 , Michael A Mao  5 , Tarun Bathini  6 , Sohail Abdul Salim  1 , Sreelatha Katari  7 , Lee S Cummings  7 , Eddie Island  7 , Jameson Forster  7 , Napat Leeaphorn  7
Affiliations

Degree of Glomerulosclerosis in Procurement Kidney Biopsies from Marginal Donor Kidneys and Their Implications in Predicting Graft Outcomes

Wisit Cheungpasitporn et al. J Clin Med. .

Abstract

Background: This study aimed to assess the association between the percentage of glomerulosclerosis (GS) in procurement allograft biopsies from high-risk deceased donor and graft outcomes in kidney transplant recipients. Methods: The UNOS database was used to identify deceased-donor kidneys with a kidney donor profile index (KDPI) score > 85% from 2005 to 2014. Deceased donor kidneys were categorized based on the percentage of GS: 0-10%, 11-20%, >20% and no biopsy performed. The outcome included death-censored graft survival, patient survival, rate of delayed graft function, and 1-year acute rejection. Results: Of 22,006 kidneys, 91.2% were biopsied showing 0-10% GS (58.0%), 11-20% GS (13.5%), >20% GS (19.7%); 8.8% were not biopsied. The rate of kidney discard was 48.5%; 33.6% in 0-10% GS, 68.9% in 11-20% GS, and 77.4% in >20% GS. 49.8% of kidneys were discarded in those that were not biopsied. Death-censored graft survival at 5 years was 75.8% for 0-10% GS, 70.9% for >10% GS, and 74.8% for the no biopsy group. Among kidneys with >10% GS, there was no significant difference in death-censored graft survival between 11-20% GS and >20% GS. Recipients with >10% GS had an increased risk of graft failure (HR = 1.27, p < 0.001), compared with 0-10% GS. There was no significant difference in patient survival, acute rejection at 1-year, and delayed graft function between 0% and 10% GS and >10% GS. Conclusion: In >85% KDPI kidneys, our study suggested that discard rates increased with higher percentages of GS, and GS >10% is an independent prognostic factor for graft failure. Due to organ shortage, future studies are needed to identify strategies to use these marginal kidneys safely and improve outcomes.

Keywords: glomerulosclerosis; kidney transplantation; outcomes; procurement kidney biopsy; transplantation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier death-censored graft survival curves between 0–10% and >10% allograft glomerulosclerosis (GS) groups.
Figure 2
Figure 2
Kaplan–Meier death-censored graft survival curves according to percent glomerulosclerosis (GS) in allografts.
Figure 3
Figure 3
Kaplan–Meier death-censored graft survival curves between the kidney donor profile index (KDPI) 71–85% group and the KDPI >85% with 0–10% percent glomerulosclerosis (GS) group.
See this image and copyright information in PMC

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