Results of Kidney Transplantation from High–Terminal Creatinine Donors and the Role of Time-Zero Biopsy

Abstract

Background Deceased-donor kidney transplantation (DDKT) from high–terminal creatinine donors is associated with lower graft survival. These kidneys may be considered for discarding, worsening the organ shortage crisis. Using time-zero biopsy for histologic evaluation of these kidneys, we identified those organs eligible for transplantation, seeking to achieve better graft utility with comparable outcomes. Methods From April 2004 to April 2008, 55 patients underwent DDKT. A time-zero biopsy was used to examine glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriolar narrowing. A scoring system was used to determine a discard. Results Twenty-five patients received DDKT from donors whose terminal creatinine levels were >2.0 mg/dL (high terminal creatinine, HTC group) and 30 from donors whose terminal creatinine levels were <2.0 mg/dL (low terminal creatinine, LTC group). Patients who accepted kidneys from HTC donors had shorter waiting times ( P = .011) but a higher incidence of delayed graft function after transplantation ( P < .001). Nonetheless, 5-year graft survival rates were similar between the two groups. Conclusions With a time-zero biopsy for histologic evaluation, kidneys recovered from high–terminal creatinine donors can be transplanted to overcome the organ shortage while achieving reasonable graft survival.