Pre-Transplantation Biopsy-Proven Severe Tubular Injury Prolonged the Allograft Function Recovery After Deceased Kidney Transplantation

Abstract

Background and Objectives The association between the pre-transplantation histologic acute tubular injury (ATI) and allograft function recovery after deceased kidney transplantation (KT) was unclear. This study aimed to evaluate the effect of ATI on the risk of DGF and the recovery time from DGF after deceased KT. Methods We retrospectively reviewed the pre-transplantation kidney biopsy from 141 kidney allograft recipients using deceased donor in the first affiliated hospital of Sun-Yat Sen University from Jan 2012 to June 2017. No organs from executed prisoners were used. ATI was assessed by two pathologists and the defrosted paraffin core biopsies were used for the assessment. Severe ATI is defined as extremely flattening of the tubular epithelia cells or the exposure of the basal membrane. DGF is defined as the need for dialysis within the first week post-transplant. DGF recovery time is defined as the time required to achieve stable serum creatinine level. The donor characteristics, the incidence of DGF and the recovery time from DGF were compared between severe ATI group and non-severe ATI group. Results There were 18 and 123 recipients in severe ATI group and non-severe ATI group respectively. Severe ATI was associated with increased donor terminal serum creatinine (median 260 vs 86.3 umol/L, p=0.001) and increased proportion of cardiac death (77.8% vs 30.1%, p<0.001). A significant increase in the risk of DGF was identified in severe ATI group compared with non-severe group (10/18, 55.6% vs 18/123, 14.6%, p<0.001; OR 7.32, 95% confidence interval 2.53-20.9, p<0.001). DGF recovery time was also prolonged in severe ATI group compared with non-severe group (49.6±10.5 vs 26.3±17.0, p<0.001). Conclusion Pre-transplantation kidney biopsy facilitated the evaluation of acute kidney injury and warm-ischemia-induced injury in the donor. Severe pre-transplantation histological ATI increased the risk of DGF and prolonged the recovery from DGF after deceased kidney transplantation.