Using implantation biopsies as a surrogate to evaluate selection criteria for living kidney donors.
BACKGROUND
The acceptance criteria used for living kidney donors are largely theoretical, as they are not clearly linked to outcomes. The goal of this study was to use implantation biopsies as a surrogate outcome marker to evaluate our living kidney donor selection criteria.


METHODS
One thousand six hundred sequential living kidney donor biopsies were performed between 2001 and 2011. Implantation biopsies were assessed by dedicated renal pathologists according to the Banff criteria. Biopsies with any chronic score of 2 or higher were deemed to have moderate to severe changes (MSC).


RESULTS
MSC was present in 4% (n=65) of implantation biopsies and occurred across a wide range of age and other demographics. By multivariate analysis, donor age (odds ratio [95% confidence interval], 1.060 [1.035-1.086]; P<0.0001) and donor systolic blood pressure (SBP) (odds ratio [95% confidence interval], 1.022 [1.006-1.037]; P=0.0060) were associated with MSC. Donor gender, body mass index, diastolic blood pressure, glomerular filtration rate, and urinary microalbuminuria were not. MSC was further increased in donors older than 60 years with SBP>140 (30% [7 of 23]) and donors older than 60 years with SBP>140 and glomerular filtration rate above the 25th percentile (42.8% [3 of 7]). In donors younger than 60 years, combining factors did not show an increased prevalence of MSC. At follow-up, renal function was similar in donors with and without MSC.


CONCLUSIONS
MSC occurred sporadically in donors with varied characteristics. Although we did not detect patterns to support specific changes in our acceptance criteria, certain subgroups of donors might benefit from close follow-up.
1 William J. Von Liebig Transplant Center, Mayo Clinic College of Medicine, Rochester, MN. 2 Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN. 3 Address correspondence to: Mark D. Stegall, M.D., Transplant Center, Rochester Methodist Hospital, 10th Floor, Charlton Building, 201 West Center Street, Rochester, MN 55902.
Ashutosh
A
Chauhan
Tayyab S
TS
Diwan
Carlos R
CR
Franco Palacios
Patrick G
PG
Dean
Julie K
JK
Heimbach
George K
GK
Chow
Mikel
M
Prieto
Fernando G
FG
Cosio
Sandra J
SJ
Taler
Stephen C
SC
Textor
Yogish C
YC
Kudva
Lynn D
LD
Cornell
Mark D
MD
Stegall
D000328:Adult; D000367:Age Factors; D001706:Biopsy; D001794:Blood Pressure; D046148:Donor Selection; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome