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Kidney Week

Abstract: FR-PO1025

Is There a Role for Implantation Biopsies in the Era of Kidney Donor Profile Index (KDPI)?

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational


  • Francalacci, Luis C, University of California, Davis, Sacramento, California, United States
  • Chen, Ling-Xin, University of California, Davis, Sacramento, California, United States
  • Perez, Richard V., University of California, Davis, Sacramento, California, United States
  • De Mattos, Angelo M., University of California, Davis, Sacramento, California, United States

Implantation biopsies (IBx) are commonly performed after deceased donor kidney transplantation (DD). However, its role in the management of these grafts and the impact on outcomes are not fully described. We evaluated the role of IBx on short and long term graft outcomes and their relationships with KDPI.


We analyzed all the DD performed at our center between 2007 and 2013. Grafts not eligible for IBx (en-bloc pediatric) were excluded. Multivariable analysis was used to adjusted for confounding variables.


Out of 885 DD performed, 477 had a IBx and 411 had not. The two groups were not different in terms of gender, age, race (donors and recipients), re-transplant, diabetes, PRA, or HLA mismatches, proportions of ECD, DCD, deaths from CVA, local procurement, pulsatile perfusion, terminal creatinine, and distribution of KDPI. There was a lower proportion of DCD in the IBx group (15 vs 21%, p=.02) and lower mean cold ischemic time - CIT (23 vs 25h, p=.006).
The IBx group had a significantly better one year graft survival (96 vs 91%, p=.001). By multivariable analysis IBx was associated with 60% (CI 21.9 – 72.1%, p=.002) decreased risk of graft loss within the first year when adjusted by DCD, KDPI, and cold ischemia time.
Long term graft survival was worse across strata of KDPI (p=.006). However, there were no difference in graft survival between the IBx and no-IBx groups (p=.16), even within the strata of KDPI: <35% (p=.7), 35 – 85% (p=.1), and >85% (p=.7). The composite chronicity score: (glomerulosclerosis-GS plus interstitial fibrosis-IF) was different across strata of KDPI (14, 44, and 66%, p<.001). However, there were no differences in graft survival by the percentage of GS (p=.4), IF (p=.4), or GS+IF (p=.08) on IBx. There was a lower incidence of delayed graft function on the IBx group (19 vs 31%, p<.001) that persisted even after adjustment for CIT and DCD. There were differences in e-GFR at 1, 3, and 5 years across strata of KDPI. However, no differences in e-GFR were found between the IBx and no IBx groups at the same time points.


Implantation biopsy is independently associated with better one year graft survival. However, KDPI becomes the most important factor associated with long term graft survival. The specific management modifications based on the results of IBx should be the focus of future investigation.


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