11-Year Single-Center Experience in Living-Donor Kidney Transplantation in Poland

The relation between zero-time pretransplant deceased donor renal biopsy and kidney transplant survival

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, Mash-had, 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.

Can zero-hour cortical biopsy predict early graft outcomes after living donor renal transplantation?

INTRODUCTION

The aim of this study was to identify relevance of subclinical pathological findings in the kidneys of living donors and correlate these with early graft renal function.

METHODS

This was a prospective study on 84 living donor kidney transplant recipients over a period of two years. In all the donors, cortical wedge biopsy was taken and sent for assessment of glomerular, mesangial, and tubule status. The graft function of patients with normal histology was compared with those of abnormal histological findings at one, three, and six months, and one year post-surgery.

RESULTS

Most abnormal histological findings were of mild degree. Glomerulosclerosis (GS, 25%), interstitial fibrosis (IF, 13%), acute tubular necrosis (ATN 5%), and focal tubal atrophy (FTA, 5%) were the commonly observed pathological findings in zero-hour biopsies. Only those donors who had histological changes of IF and ATN showed progressive deterioration of renal function at one month, three months, six months, and one year post-transplantation. In donors with other histological changes, no significant effect on graft function was observed.

CONCLUSIONS

Zero-hour cortical biopsy gave us an idea of the general status of the donor kidney and presence or absence of subclinical pathological lesions. A mild degree of subclinical and pathological findings on zero-hour biopsy did not affect early graft renal function in living donor kidney transplantation. Zero-hour cortical biopsy could also help in discriminating donor-derived lesions from de novo alterations in the kidney that could happen subsequently.

Kidney transplantation from living donors genetically related or unrelated to the recipients: a single-center analysis

Living-donor programs have gradually become an attractive strategy to expand the donor pool for kidney transplantation (KT). Grafts from living-related donors (LRD) display superior function and longer survival than those obtained from cadaveric sources. Recent reports have shown that outcomes from living-unrelated donors (LUD) are not worse than those from LRD. In this study, we evaluated 135 procedures using living donors performed in our center between 1987 and 2010 (LRD: n = 111; LUD: n = 24). Among the LRD, most donors were mothers (n = 61; 54.95%), fathers (n = 25; 22.52%), and sisters (n = 16; 14.41%). The LUD included wives (n = 17; 70.83%) and husbands (n = 7; 29.17%). The mean recipient ages for LRD versus LUD were 26.94 ± 13.51 and 50.04 ± 8.86 years, respectively (P < .0001). The recipient female/male distribution was 33/78 (29.73%/70.27%) for the LRD versus 6/18 (25%/75%) for the LUD group (P = .643). The donor age was 48.79 ± 9 years in LRD and 49.25 ± 8.44 years in LUD (P = .696). The donor female/male distribution was 72/39 (64.86%/35.16%) in LRD and 17/7 (70.83%/29.17%) in LUD (P = .576). The follow up was 123.79 ± 87.87 months (range, 0.91-279.93). Overall patient and graft survivals were 94.1% and 67.6%, respectively. There was no significant difference in patient survival after stratifying for donor type (LRD: 93.9%; LUD: 95.8%; P = .961) or in graft survival after stratifying for donor type (LRD: 63.8%; LUD: 87.8%; P = .124). Entering donor type as an independent variable in a univariate Cox regression, we observed no significance for either recipient (P = .961) or graft survival (P = .142). The results of this study suggest that LUD utilization should be encouraged in KT programs.