Post-transplantation morphological and functional changes in kidneys from expanded criteria donors

Area of Science:

• Nephrology
• Transplantation Immunology
• Pathology

Background:

• Organ transplantation faces challenges with increasing waitlists, necessitating re-evaluation of donor criteria.
• Expanded criteria donors (ECDs) offer a potential solution to organ shortages but require careful assessment.

Purpose of the Study:

• To compare kidney function and morphology between expanded criteria donor (ECD) and ideal donor kidneys (IDKs) at 1 and 5 years post-transplantation.
• To determine if ECD kidneys exhibit distinct functional or histological outcomes compared to IDKs.

Main Methods:

• Retrospective analysis of 97 patients receiving ECD kidneys and 178 patients receiving IDK.
• Comparison of serum creatinine levels and estimated glomerular filtration rates (eGFR) at 1 and 5 years post-transplant.
• Histopathological examination of transplanted kidneys for morphological changes at 1 year post-transplant.

Main Results:

• No significant difference in kidney function between ECD and IDK groups at 1 year post-transplant.
• Significantly higher serum creatinine and lower eGFR in the ECD group compared to the IDK group at 5 years post-transplant (p < 0.003).
• Increased prevalence of tubulitis and interstitial inflammation in ECD kidneys at 1 year post-transplant (p < 0.025).

Conclusions:

• Morphological differences are detectable in ECD kidneys as early as 1 year post-transplantation, despite similar initial function.
• Long-term follow-up reveals functional disparities, with ECD kidneys showing reduced function by 5 years.
• These findings highlight the importance of considering donor criteria in kidney transplantation outcomes.