title: Prognostic utility of preimplantation kidney biopsy from deceased older donors in first year post-transplant renal function.
abstract: BACKGROUND
  Preimplantation renal biopsy provides potentially valuable information about post-transplant renal function.
  
  
  OBJECTIVE
  To assess the prognostic value of preimplantation kidney biopsy from older donors in determining 1-year post-transplant estimated glomerular filtration rate MDRD-4 (eGFR).
  
  
  METHODS
  We evaluated a cohort of 124 renal transplant recipients from deceased donors ≥60 years old, performed at our center between March 2008 and May 2012. Biopsies were assessed by applying the score proposed by O'Valle et al. The overall score was stratified into 3 levels: 0-3, 4-5 and 6-8 points. Kidneys scoring > 8 points were discarded. A total of 77% of the donors were ≥70 years.
  
  
  RESULTS
  One year post-transplant, mean eGFR (SD) was lower in transplant recipients with 6-8 points (38.5 [14.1] mL/min/1.73m(2)) than in the group scoring 4-5 points (46.3 [15.7] [p=0.03]) and the group scoring 0-3 (49.6 [12.5] [P=.04]). Seven patients (19%) had eGFR <30mL/min/1.73m(2) 1 year post-transplant in group 6-8 vs. 8 (14%) in group 4-5 and none in group 0-3. In the logistic regression, OR (95% IC), to determine patients with 1-year post-transplant eGFR (<30mL/min/1.73m(2)), delayed graft function (6.3 [1.9-21.3]) and acute rejection (5.8 [1.1-31]), were significant. The adjusted OR of biopsy score group 6-8 vs. 0-5, was 2.2 (0.7-7.3).
  
  
  CONCLUSIONS
  Allografts with higher pathologic score in preimplantation renal biopsy were associated with a worse 1-year post-transplant eGFR. Delayed graft function and acute rejection were significant risk factors for 1-year post-transplant low eGFR.
authors.affiliation: Servicio de Nefrología, Hospital Universitario Cruces-BioCruces Health Research Institute, Barakaldo, España. Electronic address: juanjose.amenabariribar@osakidetza.eus.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Amenábar
authors.affiliation: Servicio de Nefrología, Hospital Universitario Cruces-BioCruces Health Research Institute, Barakaldo, España.
authors.forename: Jhon A
authors.initials: JA
authors.lastname: Camacho
authors.affiliation: Servicio de Nefrología, Hospital Universitario Cruces-BioCruces Health Research Institute, Barakaldo, España.
authors.forename: Nerea
authors.initials: N
authors.lastname: Gómez-Larrambe
authors.affiliation: Servicio de Nefrología, Hospital Universitario Cruces-BioCruces Health Research Institute, Barakaldo, España.
authors.forename: Teresa
authors.initials: T
authors.lastname: Visus
authors.affiliation: Unidad de Epidemiología Clínica, Hospital Universitario Cruces-BioCruces Health Research Institute, Barakaldo, España.
authors.forename: José I
authors.initials: JI
authors.lastname: Pijoan
authors.affiliation: Servicio de Anatomía Patológica, Hospital Universitario Cruces-BioCruces Health Research Institute, Barakaldo, España.
authors.forename: Jaime
authors.initials: J
authors.lastname: González del Tánago
authors.affiliation: Servicio de Nefrología, Hospital Universitario Cruces-BioCruces Health Research Institute, Barakaldo, España.
authors.forename: Sofía
authors.initials: S
authors.lastname: Zárraga
authors.affiliation: Servicio de Urología, Hospital Universitario Cruces-BioCruces Health Research Institute, Barakaldo, España.
authors.forename: Jorge
authors.initials: J
authors.lastname: García-Olaverri
authors.affiliation: Servicio de Nefrología, Hospital Universitario Cruces-BioCruces Health Research Institute, Barakaldo, España.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Gaínza
mesh_terms: D001706:Biopsy; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
keywords: Biopsia renal preimplante; Donante con criterio expandido; Donante fallecido de edad avanzada; Expanded criteria donor; Filtrado glomerular; Glomerular filtration rate; Kidney transplantation; Older deceased donor; Preimplantation kidney biopsy; Trasplante renal