Kidney transplantation from living donor: Does pre-implantation biopsy predicts outcome?

H. Nassereddine, S. Aydin, L. Elens, V. Haufroid, M. de Meyer, N. Kanaan, A. Jouret-Mourin, M. Mourad

Friday 16 march 2018

11:40 - 11:50h at Van Rijck/Ruys Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 15: Clinical

Introduction

Pre-implantation biopsy is considered a valuable decision-making tool for renal transplantation but majority of studies concerned deceased donors. Data available from studies ofpre-implantation kidney biopsy from living donor are rare.

Objectives

The aim of this study was to identify clinical variables and subclinical pathological findings on pre-implantation biopsies from living donor and to correlate these findings with graft outcome.

Methods

We evaluated 152 living donor biopsies performed at our center between October 2005 and March 2016. Time-zero biopsies were evaluated using the Remuzzi score and the Banff histopathological consensus criteria for preimplantation kidney biopsies. To estimate the overall effect of covariates on the renal function (as assessed by serum creatinine levels), mixed-model analysis for longitudinal data were performed based on the maximum likelihood ratio with the covariate(s) set as fixed factor and the time of follow-up as repeated measurement.

Results

According to Remuzzi score, global glomerulosclerosis, tubular atrophy, interstitial fibrosis and vascular fibrous intimal thickening were mostly absent or of mild degree. Using the Banff score, interstitial fibrosis, tubular atrophy, interstitial inflammation, arterial intimal fibrosis, and arteriolar hyalinosis were also mostly absent or of mild degree. Glomerular thrombi, focal segmental glomerulosclerosis, nodular glomerulosclerosis and tumor were absent. Acute tubular injury/necrosis of mild degree was observed in 86% (131/152) of time-zero biopsies. Global glomerulosclerosis (GS) was observed in 74% (112/152) of cases. Mean percentage of global GS was 8.75% (median: 4.76%; range: 0 –90.91%). Mesangial IgA nephritis was incidentally discovered in 8% (12/152) of biopsies. In univariate analysis, using mixed model for repeated-measures, kidneys from female donors, presence of acute tubular injury/necrosis (ATI/N) and donor age > 55 years were associated with higher recipient serum creatinine values (p<0.0001). Analyzing the effect of these covariates jointly in multivariate analysis revealed that acute tubular injury/necrosis, donor age and donor gender were independently related to graft function during the whole follow-up period covering up to 10-years post-graft (p <,0001; p = 0,0241; p = 0,0018, respectively).

Conclusions

The results of this study demonstrate the impact of donor age, donor gender and of ATI/N on early and late graft function.