title: A single-center cohort study to define the role of pretransplant biopsy score in the long-term outcome of kidney transplantation.
abstract: BACKGROUND
  The role of pretransplant biopsy in defining the quality of kidney grafts is still debated. The aim of this study was to investigate the influence of pretransplant biopsy score on long-term graft outcome.
  
  
  METHODS
  In a retrospective cohort study, we analyzed 372 recipients of single kidney transplantation (SKT) from deceased donors between 1997 and 2007, with an available pretransplant biopsy. We evaluated 5- and 10-year graft survival, incidence of delayed graft function, and estimated glomerular filtration rate at 1 and 5 years.
  
  
  RESULTS
  Graft survival at 5 and 10 years was significantly better for recipients with a score of 0 compared to transplants with a score of 1 to 5, whereas we did not observe any significant difference among transplants with a score of 1 through 4. Survival of kidneys with a score of 5 was significantly worse compared to grafts with a score of 1 to 4. In a multivariate Cox model, only pretransplant histological score was significantly associated with graft survival. Transplants with a score of 0 and 5 had the best and the worst graft function, respectively, both at 1 and 5 years, whereas we did not observe any difference among patients with a score of 1 through 4. In a multivariate logistic regression, pretransplant histological score was independently associated with the prevalence of an estimated glomerular filtration rate less than 30 mL/min at 5 years. Finally, delayed graft function rate was significantly higher in recipients with a score of 5 compared to patients with a score of 1 to 4 and score of 0.
  
  
  CONCLUSIONS
  Our data suggest that 1) pretransplant histological score may predict long-term graft outcome and 2) allocation of kidneys with a score of 4 to SKT provides an acceptable long-term graft function and survival.
authors.affiliation: 1 Department of Medical and Surgical Sciences, Nephrology, Dialysis and Transplantation Unit, University of Foggia, Foggia, Italy. 2 Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy. 3 Department of Emergency and Organ Transplantation, Andrology, Urology and Renal Transplantation Unit, University of Bari, Bari, Italy. 4 Address correspondence to: Giovanni Stallone, M.D., Department of Medical and Surgical Sciences, Nephrology, Dialysis and Tranplantation Unit, University of Foggia, Viale Luigi Pinto, 1, 71100 Foggia, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Losappio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Stallone
authors.forename: Barbara
authors.initials: B
authors.lastname: Infante
authors.forename: Antonio
authors.initials: A
authors.lastname: Schena
authors.forename: Michele
authors.initials: M
authors.lastname: Rossini
authors.forename: Annamaria
authors.initials: A
authors.lastname: Maiorano
authors.forename: Marco
authors.initials: M
authors.lastname: Fiorentino
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ditonno
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucarelli
authors.forename: Michele
authors.initials: M
authors.lastname: Battaglia
authors.forename: Loreto
authors.initials: L
authors.lastname: Gesualdo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grandaliano
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D051799:Delayed Graft Function; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome