Time-zero renal biopsy in living kidney transplantation: a valuable opportunity to correlate predonation clinical data with histological abnormalities.
BACKGROUND
Living kidney donation is increasing as a partial solution for wait-listed patients. Despite properly followed guideline criteria for donor selection, current reports identify unsuspected renal pathology at preimplantation or time-zero biopsy (T0-RBx).


METHODS
T0-RBx was evaluated for following: interstitial fibrosis (IF), tubular atrophy (TA), arteriolar hyalinosis (AH), mesangial increase (MI), and glomerulosclerosis (GS). Predonation data were demography, body weight, body mass index (BMI), systolic/diastolic blood pressure (BP), serum creatinine (SCr), estimated glomerular filtration rate (eGFR), and proteinuria.


RESULTS
Two hundred nineteen T0-RBx were analyzed. Of these 54.4% had abnormal findings, namely, IF in 29%, TA in 13%, MI in 12%, AH in 10%, and GS in 10%. Mean clinical data were as follows: age 35.4+/-10 years, weight 66.27+/-10.14 kg, BMI 25.53+/-2.99, systolic BP 115+/-9 mm Hg, diastolic BP 74+/-7 mm Hg, SCr 0.91+/-0.25 mg/dL, eGFR 96+/-16.65 mL/min, and proteinuria 70.25+/-62.8 mg/24 hr. A total of 56.7% were women. IF correlated to age (r=0.22, P=0.001) and SCr (r=0.19, P=0.005); TA to diastolic BP (r=0.15, P=0.03) and proteinuria (r=0.20, P=0.009); AH to SCr (r=0.15, P=0.02) and eGFR (r=-0.16, P=0.018); MI to BMI (r=0.13, P=0.047). Multivariate analysis failed to sustain the significant associations found on bivariate analysis, most likely due to a low event/parameter relation and sample size.


CONCLUSIONS
A significant correlation was established between T0-RBx findings and clinical predonation parameters. Whether these mild histologic findings at the time of kidney donation represent a higher risk for the remaining kidney ought to be evaluated during follow-up. In an era, when living kidney donation is increasing, we advise closer donor surveillance to modify risk factors that participate in kidney damage progression.
Mancilla
Eduardo
E
Departamento de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Mexico City, Mexico.
Avila-Casado
Carmen
C
Uribe-Uribe
Norma
N
Morales-Buenrostro
Luis E
LE
Rodríguez
Francisco
F
Vilatoba
Mario
M
Gabilondo
Bernardo
B
Aburto
Salvador
S
Rodríguez
Roxana M
RM
Magaña
Salvador
S
Magaña
Fernando
F
Alberú
Josefina
J
D001706:Biopsy; D001794:Blood Pressure; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007668:Kidney / Q000002:abnormalities* / Q000473:pathology* / Q000502:physiology; D007674:Kidney Diseases / Q000453:epidemiology / Q000473:pathology; D007678:Kidney Glomerulus / Q000473:pathology; D016030:Kidney Transplantation / Q000473:pathology / Q000502:physiology*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D018579:Patient Selection; D011507:Proteinuria / Q000453:epidemiology; D012079:Renal Circulation / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014850:Waiting Lists