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Abstract: FR-PO900

Clinicopathologic Characteristics of Kidney Allografts with Donor-Derived Diabetic Nephropathy

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Jen, Kuang-Yu, University of California, Davis, Sacramento, California, United States
  • Lee, Hannah, UCSF, Cupertino, California, United States
  • Chen, Ling-Xin, University of California, Davis, Sacramento, California, United States
  • Gao, Guofeng, University of California, Davis, Sacramento, California, United States
  • Sageshima, Junichiro, University of California, Davis, Sacramento, California, United States
Background

The general consensus is that donor kidneys with biopsy proven diabetic nephropathy (DN) should be discarded, although data regarding outcomes of these cases is lacking. In this study, the clincopathologic characteristics of allografts with moderate to advanced donor-derived DN was examined.

Methods

Retrospective analysis (between 06/2011 to 01/2017) of all kidney transplant recipients with biopsy proven class II or III DN within the first six months post-transplantation was performed. For each patient, all biopsies were reviewed to assess progression/regression in disease. Glomerular changes were classified based on Tervaert pathologic classification. Associated clinical data were extracted from electronic medical records, including donor information.

Results

Fifteen recipients received donor kidneys with DN from 11 donors. All but one donor had confirmed history of long-standing diabetes, while 47% of recipients had history of diabetes. Nine grafts had class III, two had class IIb, and four had class IIa donor-derived DN. Mean clinical follow up time was 13.2 months (range 3-30 months). Four grafts (27%) failed within the first year, three of which were due to primary non-function and one showed slow graft function without need for dialysis but had subsequent rapid deterioration within 9 months. Two failed grafts had class IIb and two had class III DN, while none of the class IIa grafts failed. Two of the failed grafts had contralateral sister kidneys that demonstrated good renal function. Of the functional grafts, four (36%) experienced delayed graft function. Average creatinine at latest follow up for functional grafts was 1.4 mg/dL, and none experienced rejection episodes. No significant histologic progression/regression in DN class was observed, and no histologic findings on initial biopsy were significant for predicting graft failure.

Conclusion

Despite the high incidence of failed grafts, 73% of recipients in this cohort experienced successful transplantation using kidneys with moderate to advanced donor-derived DN. Although no histologic findings were statistically significant for predicting graft failure, the grafts that failed showed either class IIb or III DN and not class IIa DN, suggesting that kidenys with class IIa DN may be safe to use.