title: Long-term Renal Function in Living Kidney Donors Who Had Histological Abnormalities at Donation.
abstract: Recent evidence suggests that living kidney donors are at an increased risk of end-stage renal disease. However, predicting which donors will have renal dysfunction remains challenging, particularly among those with no clinical evidence of disease at the time of donation. Although renal biopsies are not routinely performed as part of the donor evaluation process, they may yield valuable information that improves the ability to predict renal function in donors.
  
  
  
  We used implantation protocol biopsies to evaluate the association between histological abnormalities in the donated kidney and postdonation renal function (estimated glomerular filtration rate, eGFR) of the remaining kidney in living kidney donors. Longitudinal analysis using mixed-effects linear regression was used to account for multiple eGFR measures per donor.
  
  
  
  Among 310 donors between 1997 and 2012, median (IQR) follow-up was 6.2 (2.5-8.7; maximum 14.0) years. In this cohort, the overall prevalence of histological abnormalities was 65.8% (19.7% abnormal glomerulosclerosis, 23.9% abnormal interstitial fibrosis and tubular atrophy (IFTA), 4.8% abnormal mesangial matrix increase, 32.0% abnormal arteriolar hyalinosis, and 32.9% abnormal vascular intimal thickening). IFTA was associated with a 5-mL/min/1.73 m decrease of postdonation eGFR after adjusting for donor age at donation, sex, race, preoperative systolic blood pressure, preoperative eGFR, and time since donation (P < 0.01).
  
  
  
  In this single-center study, among healthy individuals cleared for living donation, IFTA was associated with decreased postdonation eGFR, whereas no other subclinical histological abnormalities provided additional information.
authors.affiliation: 1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 2 Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD. 3 Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Lara M
authors.initials: LM
authors.lastname: Fahmy
authors.forename: Allan B
authors.initials: AB
authors.lastname: Massie
authors.forename: Abimereki D
authors.initials: AD
authors.lastname: Muzaale
authors.forename: Serena M
authors.initials: SM
authors.lastname: Bagnasco
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Orandi
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Alejo
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Boyarsky
authors.forename: Saad K
authors.initials: SK
authors.lastname: Anjum
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: Nabil N
authors.initials: NN
authors.lastname: Dagher
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D001741:Black or African American; D001706:Biopsy; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D012306:Risk