TY - JOUR
T1 - Correlation of histologic findings on preimplant biopsy with kidney graft survival
AU - Kayler, Liise K.
AU - Mohanka, Ravi
AU - Basu, Amit
AU - Shapiro, Ron
AU - Randhawa, Parmjeet S.
PY - 2008/9
Y1 - 2008/9
N2 - Kidney biopsies are being used to evaluate marginal deceased donor organs, but, the literature on the utility of this practice remains conflicting. We re-examined this issue by performing a multivariate analysis of 597 kidney transplant recipients. The presence of moderate arteriosclerosis and/or moderate arteriolosclerosis (MA), defined as ≥25% luminal compromise, was a significant predictor of graft outcome in standard criteria donors (multivariate, P = 0.01) and in expanded criteria donors (ECD) as defined by UNOS criteria (univariate P = 0.02). One-, 3-, and 5-year overall allograft survival with MA was 71%, 58%, and 40%, respectively. Increasing degrees of glomerulosclerosis (GS) were associated with earlier graft failure on univariate (P = 0.03) but not multivariate analysis (P = 0.36). GS > 20% and interstitial fibrosis >25% had a low frequency in the material reviewed, likely reflecting our organ utilization practices, and did not have a demonstrable effect on graft outcome. Clinical parameters independently associated with worse graft function were ECD status (P < 0.05), retransplantation (P = 0.004), recipient age (P < 0.05), and delayed graft function (P < 0.0001). Donor vascular disease is an independent risk factor for suboptimal graft survival. Great caution should be exercised in the decision to transplant kidneys with moderate arterial and/or arteriolar luminal narrowing.
AB - Kidney biopsies are being used to evaluate marginal deceased donor organs, but, the literature on the utility of this practice remains conflicting. We re-examined this issue by performing a multivariate analysis of 597 kidney transplant recipients. The presence of moderate arteriosclerosis and/or moderate arteriolosclerosis (MA), defined as ≥25% luminal compromise, was a significant predictor of graft outcome in standard criteria donors (multivariate, P = 0.01) and in expanded criteria donors (ECD) as defined by UNOS criteria (univariate P = 0.02). One-, 3-, and 5-year overall allograft survival with MA was 71%, 58%, and 40%, respectively. Increasing degrees of glomerulosclerosis (GS) were associated with earlier graft failure on univariate (P = 0.03) but not multivariate analysis (P = 0.36). GS > 20% and interstitial fibrosis >25% had a low frequency in the material reviewed, likely reflecting our organ utilization practices, and did not have a demonstrable effect on graft outcome. Clinical parameters independently associated with worse graft function were ECD status (P < 0.05), retransplantation (P = 0.004), recipient age (P < 0.05), and delayed graft function (P < 0.0001). Donor vascular disease is an independent risk factor for suboptimal graft survival. Great caution should be exercised in the decision to transplant kidneys with moderate arterial and/or arteriolar luminal narrowing.
KW - Arteriosclerosis
KW - Donor biopsy
KW - Expanded criteria donor
KW - Kidney transplant
KW - Outcomes
UR - http://www.scopus.com/inward/record.url?scp=49649104041&partnerID=8YFLogxK
U2 - 10.1111/j.1432-2277.2008.00681.x
DO - 10.1111/j.1432-2277.2008.00681.x
M3 - Article
C2 - 18435681
AN - SCOPUS:49649104041
SN - 0934-0874
VL - 21
SP - 892
EP - 898
JO - Transplant International
JF - Transplant International
IS - 9
ER -