Evaluation of pre-implantation kidney biopsies: comparison of Banff criteria to a morphometric approach.
BACKGROUND
Donor glomerulosclerosis, interstitial fibrosis, and fibrous intimal thickening correlate with graft outcome. We evaluate chronic lesions in donor biopsies according to Banff criteria and with a morphometric technique to ascertain their predictive value on graft outcome.


METHODS
We evaluated 77 cadaveric donor biopsies according to Banff criteria. Glomerulosclerosis was expressed as the percentage of global sclerotic glomeruli. The following morphometric parameters were obtained: cortical interstitial volume fraction (Vvint/c), cortical glomerular volume fraction (Vvglom/c), mean glomerular volume (Vg), mean and maximal intimal arterial volume fraction (Vvintima/art), and Vvintima/art of the largest artery. We evaluated the correlation of histologic lesions with delayed graft function, 3 months' glomerular filtration rate (GFR), and death-censored graft survival.


RESULTS
Multivariate logistic regression showed that delayed graft function was associated with cv score [relative risk (RR) 4.2 and 95% CI 1.1 to 16.0) and glomerulosclerosis (RR 1.06 and 95% CI 1.01 to 1.13). Stepwise regression showed that Vvint/c and glomerulosclerosis were independent predictors of 3 months' GFR (R= 0.62, P= 0.0001). Repeated analysis not considering morphometric parameters showed that glomerulosclerosis, cv score and ci score were independent predictors of 3 months' GFR (R= 0.64, P= 0.0001). A donor chronic damage score was generated considering glomerulosclerosis, cv score and ci score. This score after adjusting for clinical variables was associated with 3 months' GFR (R= 0.71, P < 0.0001) and death-censored graft survival (RR 2.2 and 95% CI 1.3 to 3.7).


CONCLUSIONS
Combined evaluation of donor glomerulosclerosis, chronic vascular and interstitial damage according to Banff criteria allows a precise prediction of graft outcome. Morphometric evaluation of donor biopsies does not improve the predictive value of semiquantitative grading.
Lopes
José António
JA
Department of Nephrology, Hospital Universitari de Bellvitge, Barcelona, Spain.
Moreso
Francesc
F
Riera
Luis
L
Carrera
Marta
M
Ibernon
Meritxell
M
Fulladosa
Xavier
X
Grinyó
Josep Maria
JM
Serón
Daniel
D
D000328:Adult; D000367:Age Factors; D000368:Aged; D001706:Biopsy; D002102:Cadaver; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology / Q000166:cytology* / Q000473:pathology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D016896:Treatment Outcome