title: Baseline donor chronic renal injury confers the same transplant survival disadvantage for DCD and DBD kidneys.
abstract: Histological assessment of baseline chronic kidney injury may discriminate kidneys that are suitable for transplantation, but has not been validated for appraisal of donation after circulatory death (DCD) kidneys. 'Time-zero' biopsies for 371 consecutive, solitary, deceased-donor kidneys transplanted at our center between 2006 and 2010 (65.5% DCD, 34.5% donation after brain death [DBD]) were reviewed and baseline chronic degenerative injury scored using Remuzzi's classification. High scores correlated with donor age and extended criteria donors (42% of donors), but the spectrum of scores was similar for DCD and DBD kidneys. Transplant outcomes for kidneys scoring from 0 to 4 were comparable (1 and 3 year graft survival 95% and 92%), but were much poorer for kidneys scoring ≥5, with 1 year graft survival only 73%, and 12.5% suffering primary nonfunction. Critically, high Remuzzi scores conferred the same survival disadvantage for DCD and DBD kidneys. On multi-variable regression analysis, time-zero biopsy score was the only independent predictor for graft survival, whereas one-year graft estimated glomerular filtration rate (eGFR) correlated with donor age and biopsy score. In conclusion, the relationship between severity of chronic kidney injury and transplant outcome is similar for DCD and DBD kidneys. Kidneys with Remuzzi scores of ≤4 can be implanted singly with acceptable results.
authors: Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
authors: V
authors: V
authors: Kosmoliaptsis
authors: M
authors: M
authors: Salji
authors: V
authors: V
authors: Bardsley
authors: Y
authors: Y
authors: Chen
authors: S
authors: S
authors: Thiru
authors: M H
authors: MH
authors: Griffiths
authors: H C
authors: HC
authors: Copley
authors: K
authors: K
authors: Saeb-Parsy
authors: J A
authors: JA
authors: Bradley
authors: N
authors: N
authors: Torpey
authors: G J
authors: GJ
authors: Pettigrew
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007668:Kidney / Q000293:injuries*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors
keywords: Clinical research/practice; donors and donation: donation after circulatory death (DCD); kidney (allograft) function/dysfunction; kidney transplantation/nephrology; pathology/histopathology