title: Histopathological evaluation of pretransplant donor biopsies in expanded criteria donors with high kidney donor profile index: a retrospective observational cohort study.
abstract: There is no consensus on the allocation of renal transplants from expanded criteria donors (ECD). The Kidney Donor Profile Index (KDPI) is used without the need for pretransplant donor biopsies (PTDB). We explored whether PTDB based on Remuzzi Score (RS) allows identification of those marginal kidneys in the highest calculated KDPI risk group (>91%) that appropriate for single transplantation. A retrospective study was conducted of 485 consecutive kidneys procured from a single center and transplanted if the RS was ≤4. We compared 5-year kidney and patients survival between KDPI groups and between RS <4 or =4 in the highest KDPI group. The median KDPI (interquartile range) was 71 (66-76) for KDPI <80% (n = 77), 86 (81-90) for KDPI 81-90% (n = 82), and 97 (94-100) for KDPI >91% (n = 205). Patient survival at 5 years was 85.7%, 85.3%, and 76.09% (P = 0.058) and death-censored graft survival was 84.4%, 86.5%, 73.6% (P = 0.015), respectively for each KDPI group. In >91% calculated KDPI group, there were no differences in graft survival depending on the RS (<4 vs. =4) (P = 0.714). The implementation of PTDB based on RS used for allocation of organs with the highest KDPI range could support to the acceptance of suitable organs for single transplantation with good patient and graft survival rate.
authors.affiliation: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Ana
authors.identifier: http://orcid.org/0000-0002-1401-2550
authors.initials: A
authors.lastname: Sánchez-Escuredo
authors.affiliation: Pathology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Amaia
authors.initials: A
authors.lastname: Sagasta
authors.affiliation: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Revuelta
authors.affiliation: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Lida M
authors.initials: LM
authors.lastname: Rodas
authors.affiliation: Transplant Service Foundation, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Paredes
authors.affiliation: Urology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Musquera
authors.affiliation: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Fritz
authors.initials: F
authors.lastname: Diekmann
authors.affiliation: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Campistol
authors.affiliation: Pathology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Solé
authors.affiliation: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Oppenheimer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D051799:Delayed Graft Function / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D014019:Tissue Donors; D019737:Transplants / Q000592:standards*
keywords: biopsies; expanded criteria donors; kidney donor profile index