Kidney Week

Abstract: FR-PO1024

The Deceased Donor Implantation Biopsy and Histopathological Characteristics for Predicting Graft Outcomes in Kidney Transplant Recipients

Session Information

• Transplantation: Donor-Candidate Assessment and Predictors of Outcome
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Transplantation

• 1702 Transplantation: Clinical and Translational

Authors

• Wang, Diping, University at Buffalo, Buffalo, New York, United States

Diping Wang,

• Yip, Cindy S, University at Buffalo, Buffalo, New York, United States

Cindy S Yip,

• Dodoo, Christopher, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States

Christopher Dodoo,

• Gundroo, Aijaz A., University at Buffalo, Buffalo, New York, United States

Aijaz A. Gundroo,

• Dwivedi, Alok K, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States

Alok K Dwivedi,

• Liu, Lin, University at Buffalo, Buffalo, New York, United States

Lin Liu,

• Chang, Shirley Shwu-Shiow, Erie County Medical Center, Buffalo, New York, United States

Shirley Shwu-Shiow Chang,

• Zachariah, Mareena Susan, Erie County Medical Center, Buffalo, New York, United States

Mareena Susan Zachariah,

• Tomaszewski, John E., University at Buffalo, Buffalo, New York, United States

John E. Tomaszewski,

Background

The allocation of deceased donor kidneys has become more complex because of the increasing spectrum of donor and recipient co-morbidities. The kidney donor risk index (KDRI) was designed to capture the donor factors known at the time of organ procurement, but donor gender, cigarette use, polysubstance abuse, glomerulonephritides, and interstitial disease are not included in the KDRI and can influence graft outcomes. In this study, we evaluted the prognostic value of pre-implantation histopathological parameters in predicting the graft function after transplantation.

Methods

Deceased donor recipients transplanted between January 2012 and March 2016 were followed up to four years were included in this study. Pre-implantation biopsies were re-evaluated per the Banff 97 classification and chronic allograft damage index (CADI) and graft function was monitored. Glomerular filtration rate (GFR) at the last visit was categorized into a staging variable (Stage) after which multinomial logistic regression was used to assess the association between stage and the cofactors. Ordinary linear regression was also used to assess the association between GFR at last visit and the cofactors. Logistic and linear regressions were used to assess the association between Banff and CADI scores and the cofactors.

Results

Inter-observer correlation between the two pathologists for total Banff score (ICC = 97%) and CADI score (ICC = 92%) were excellent. The presence of glomerulosclerosis (GS, -10.15) and tubular atrophy (TA, -10.39) in CADI score were found to be associated with final GFR. In addition to GS, glomerular mesangial matrix (GM) in CADI was also associated with stages of GFR. Only presence of glomerular mesangial matrix (CM) parameter in Banff score was found to be associated with stage and graft function. In separate multivariable analyses after adjusting for other significant variables, GM present and CM present were associated with chronic kidney disease stage.

Conclusion

A multiparametric approach may be developed by incorporating pre-implantation biopsy information along with important clinical variables to predict outcome.