Abstract: FR-PO1000
Do Preimplantation Biopsies Predict Allograft Loss and Function in Deceased-Donor Kidney Transplants?
Session Information
- Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Murthy, Anu, Montefiore Medical Center, New York, New York, United States
- Nino Torres, Laura, Montefiore Medical Center, New York, New York, United States
- Dilip, Raga, Montefiore Medical Center, New York, New York, United States
- Verzani, Zoe, Weill Cornell Medicine, New York, New York, United States
- Ajaimy, Maria, Montefiore Medical Center, New York, New York, United States
- Liriano-Ward, Luz E., Montefiore Medical Center, New York, New York, United States
- Pynadath, Cindy T., Montefiore Medical Center, New York, New York, United States
- Al Azzi, Yorg, Montefiore Medical Center, New York, New York, United States
- Jain, Swati, Montefiore Medical Center, New York, New York, United States
- Yaffe, Hillary C, Montefiore Medical Center, New York, New York, United States
- von Ahrens, Dagny, Montefiore Medical Center, New York, New York, United States
- Abdel Muhdi, Nidal, Montefiore Medical Center, New York, New York, United States
- Le, Marie, Montefiore Medical Center, New York, New York, United States
- Akalin, Enver, Montefiore Medical Center, New York, New York, United States
Background
Kidney discard rate is up to 29% in the US. Biopsy results are the reason for decline in half of the discarded kidneys. We aim to investigate donor-related factors affecting graft survival, focusing on preimplantation biopsies comparing to clinically indicated biopsies.
Methods
Retrospective analysis of all adult isolated deceased-donor kidney transplant (DDKT) between January 1, 2019 – September 30, 2024, at our center. Donors with > 20% glomerulosclerosis (GS) and > 25% interstitial fibrosis and tubular atrophy (IFTA) or vascular narrowing (VN) were declined.
Results
Of the 796 DDKT, donor median age was 43 (IQR 32-55), 36% were DCD, 32% had final sCr >2 mg/dl, with a median KDPI of 60 (IQR 37,78). Of the 583 patients with preimplantation biopsies, 12% had 10-25% VN, 3.3% had 10-25% IFTA, 9.8% had 10-20% GS. During a median follow up of 24 months (IQR 13,41), 53 patients (6.6%) died and 38 had graft loss (4.7%) and 27 had eGFR<21 ml/min (3.4%). 51% developed DGF. Comparing 38 patients with death-censored graft loss and 27 patients with eGFR < 21 ml/min to surviving patients with eGFR ≥ 21 ml/min, there was a trend but not statistically significant difference in donors with 10-25% VN (p=0.065) and 10-25% IFTA (p=0.078) and 10-20% GS (p=0.4) for graft loss and eGFR < 21ml/min. In multivariate analysis, DCD (HR 1.82, 1.07-3.08 95%CI, p=0.026) and KDPI (HR 1.01, 1.00-1.02 95%CI, p=0.044) were associated with the death-censored graft loss and eGFR < 21 ml/min as donor-related factors. 277 patients underwent graft biopsies at a median of 90 days (IQR 24-201). 58% of the biopsies had a cv score >0 and 20% had ci + ct score >2. When comparing patients with both pre and posttransplant biopsies, only 13% of the posttransplant biopsies with a cv score >0 had VN in the preimplantation biopsy, and none of the posttransplant biopsies with ci+ ct score >2 had pretransplant biopsies documenting 10-25% IFTA.
Conclusion
Preimplantation biopsies did not predict allograft loss and function after KT. A significant number of early clinically indicated biopsies documented increased vascular narrowing require further studies to explore, if it was due to posttransplant injury or poor assessment of preimplantation biopsies.