The relation between zero-time pretransplant deceased donor renal biopsy and kidney transplant survival
Received 3 August 2018
Accepted for publication 24 January 2019
Published 26 April 2019 Volume 2019:11 Pages 123—130
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Jan Colli
Mahmoud Tavakkoli,1 Masoud Yousefi,2 Reza Mahdavi,2 Mahmoud Reza Kalantari,3 Amin Mirsani,2 Amin Korooji2
1Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; 2Department of Urology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 3Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Introduction: There are several investigations about preimplantation biopsy results in alive donors. However, assessment of the biopsies in deceased donors’ kidney and its correlation with patient survival is limited. In this study, we evaluated the correlation between zero-time pretransplant kidney biopsy and survival of kidney in deceased donors.
Patients and methods: This was a cohort study conducted at Montaserieh Hospital, Mashhad, between January 2016 and December 2017. We included all brain dead patients who were referred to Montaserieh transplantation center. After vascular anastomosis of kidneys in recipient patients, in the operation room, and de-clumping of vessels, biopsies were taken from upper pole of donated kidney. Blocks of biopsies were evaluated by expert pathologists and then reported. We followed patients for 1 year and compared the pathologic findings and renal survival in them.
Results: The mean age of deceased donors was 32.32±1.49 years and that of the recipient patients was 36.33±1.27 years. Thirty-eight recipient patients (45.2%) were female and 46 were male (54.8%). The most pathologic pattern in our study was grade I separation, followed by blebs, dilatation, and loss of attenuation. We showed that most of the transplantations were safe after 1-year follow-up (85.7%) without any complications. We observed thrombosis in two cases (2.4%) and rejection of transplantation in ten patients (11.9%). Cox regression analysis showed that end-stage renal disease grade (HR =3.84, 95% CI =2.315–6.348; P<0.0001) and gender of the deceased donors (HR =0.34, 95% CI =0.145–0.797; P=0.013) were related to graft survival rate.
Conclusion: Only cast feature in pathologic exam was related to graft survival, which is a marker of tissue ischemia. There was no significant correlation between other histological findings and graft survival.
Keywords: survival rate, transplant, renal biopsy, graft outcome, kidney, deceased donors
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