Related Experiment Video
Updated: Oct 3, 2025
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Histological evaluation of ischemic alterations in donors after cardiac death: A useful tool to predict
Moreno Zagni1, Giorgio Alberto Croci1,2, Antonino Cannavò3
1Division of Pathology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Insights
Kidney biopsies from donors after cardiac death (DCD) show significant tubular damage. Quantifying these ischemic lesions accurately predicts post-transplant kidney function, improving graft quality assessment.
Area of Science:
- Nephrology
- Transplantation
- Pathology
Background:
- Kidneys from donors after cardiac death (DCD) experience ischemia-reperfusion injury, complicating transplantation.
- Current assessment using the Karpinski score doesn't account for ischemic insult or predict graft function.
- The relationship between biopsy findings and post-transplant outcomes remains unclear.
Purpose of the Study:
- To evaluate the correlation between histological features in kidney biopsies and post-transplant graft function.
- To identify and quantify specific ischemic lesions in DCD donor kidneys.
- To compare ischemic lesions in DCD donors versus donors after brain death (DBD).
Main Methods:
- Kidney biopsies from DCD donors were analyzed for glomerular, interstitial, and tubular lesions.
- The Karpinski score was calculated for DCD donor kidneys.
- Ischemic lesions were quantified and compared to DBD donor kidneys in a case-control study.
- Data were correlated with donor clinical information and post-transplant follow-up.
Main Results:
- Proximal tubule alterations are key indicators of ischemia-reperfusion injury.
- These specific histological alterations were more prevalent in DCD donors than in DBD donors.
- Quantification of ischemic tubular lesions showed a statistical correlation with the organ's functional recovery after transplantation.
Conclusions:
- Quantifying ischemic tubular lesions in DCD donor kidney biopsies is a valuable tool for predicting transplant outcomes.
- This method offers a more accurate assessment of graft quality compared to the Karpinski score.
- Histological analysis of tubular damage aids in better utilization of DCD donor kidneys.
Abstract:
Kidneys retrieved from donors after cardiac death (DCD) pose significant challenges from a clinical and technical point of view, undergoing a variable degree of ischemia-reperfusion injury. At present, the utilization of kidneys is assessed according to the Karpinski score, which does not take into account the ischemic insult and does not predict the functional recovery of the organ once transplanted. Therefore, the correlation between biopsy results and post-transplant graft function is still debated. In this study we examined kidney biopsies from DCD donors; we calculated the Karpinski score and subsequently identified and quantified the ischemic lesions in the glomerular, interstitial, and tubular compartments. These same lesions were quantified in kidney biopsies from donors after brain death (DBD) in a case-control analysis. The collected data were correlated with the clinical data of the donors and the post-transplant follow-up. Proximal tubule alterations are crucial in ischemia-reperfusion damage, showing precise histological alterations, which are more frequent in DCD than in DBD donors and are statistically correlated with functional recovery of the organ. Quantification of ischemic tubular lesions in biopsies of kidneys from DCD donors is a useful tool for predicting post-transplant renal function and a valid parameter for assessing the quality of the graft.
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01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure