Histological Evaluation of Extended Criteria Donors: Donor’s Kidney Biopsy and Graft Outcome after 5 Years of Transplantation

Paolo Carta,Lino Cirami,Giulia Ghiandai,Lorenzo Di Maria,Emma Bartaletti,Aida Larti,Leonardo Caroti

doi:10.15586/jrenhep.v4i2.77

Paolo Carta, Lino Cirami + Show 5 more

Open Access

https://doi.org/10.15586/jrenhep.v4i2.77

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Abstract

Pre-transplant kidney biopsy is routinely used to decide whether kidneys from marginal donors should be transplanted as single or double trans-plantation. This is a 5-year extension of the follow-up of a previous study. In that study, graft outcomes were compared retrospectively between a group of 44 recipients of a single kidney graft from an extended criteria donor and a Karpinski histological score of 3 or less, and another group of 56 recipients of a single transplant with a Karpinski histological score of 4 or 5. After 5 years of transplantation, there was no difference between the two groups in terms of recipient’s serum creatinine levels (1.8 ± 0.5 vs 1.9 ± 0.6 mg/dL, P = 0.5), creatinine clearance (53 ± 23 vs 49 ± 27.0 mL/min, P = 0.6), or the rates of graft loss (41% vs 49%,P = 0.5). Therefore, the choice between single and double transplant should not be made only on the basis of histological score but should be done together with the evaluation of donor’s clinical parameters, especially the renal function.

Highlights

Kidney transplantation is the best treatment for end-stage renal disease (ESRD), since it guarantees a better quality of life and longer patient survival than dialysis [1]
The use of extended criteria donors (ECDs) [2,3,4], dual kidney transplantation, non-heart beating donors [5], living and kidney paired donation [6], and ABO-incompatible transplantation [7] has increased the number of transplantations performed every year, the gap between organ’s demand and offer is still increasing. In this era researchers are investigating the promising potential of regenerative nephrology [8], an important area of research is directed to increase the number of transplantation by optimization of the usage of kidneys harvested from “always more marginal donors” to find the border between a transplantable organ and an insufficient renal function
Pre-implantation kidney biopsy is a tool to define organ transplantability and to distinguish whether a kidney from an ECD should be allocated as a single kidney transplant (SKT) or a double kidney transplant (DKT) [9]

Summary

Introduction

Kidney transplantation is the best treatment for end-stage renal disease (ESRD), since it guarantees a better quality of life and longer patient survival than dialysis [1]. The use of extended criteria donors (ECDs) [2,3,4], dual kidney transplantation, non-heart beating donors [5], living and kidney paired donation [6], and ABO-incompatible transplantation [7] has increased the number of transplantations performed every year, the gap between organ’s demand and offer is still increasing In this era researchers are investigating the promising potential of regenerative nephrology [8], an important area of research is directed to increase the number of transplantation by optimization of the usage of kidneys harvested from “always more marginal donors” to find the border between a transplantable organ and an insufficient renal function. It is a common practice nowadays to be less stringent with this threshold, and today most of the transplant centers choose an SKT even if the Karpinski histological score is 4 or 5, but this choice is based more on the experience of the transplant center, rather than on the results of published studies

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