Delayed Graft Function Under the Microscope: Surveillance Biopsies in Kidney Transplantation

Area of Science:

• Nephrology
• Transplantation Immunology
• Pathology

Background:

• Delayed graft function (DGF) is a frequent complication post-kidney transplantation.
• DGF often necessitates surveillance biopsies to assess graft health.
• Understanding histological findings and risk factors is vital for managing DGF and improving outcomes.

Purpose of the Study:

• To characterize histological findings in surveillance biopsies of deceased donor kidney transplants with DGF.
• To identify risk factors associated with graft outcomes in this population.
• To evaluate the impact of rejection on long-term graft survival.

Main Methods:

• Retrospective, monocentric study of 335 deceased donor kidney transplant recipients (356 biopsies) between 2006-2019.
• Biopsies analyzed using the Banff classification criteria.
• Multivariate analysis to determine risk factors for rejection and graft outcomes.

Main Results:

• Acute tubular necrosis (42.1%), acute rejection (26.9%), and borderline findings (25.5%) were the primary histological diagnoses.
• Recipient age and DGF duration were significant risk factors for acute rejection (p=0.028, p=0.005).
• Anti-thymocyte globulin (ATG) antibody induction therapy showed a protective effect against rejection (p=0.001).

Conclusions:

• Surveillance biopsies are essential for managing kidney grafts experiencing DGF.
• Recipient age and DGF duration are independent predictors of acute rejection.
• ATG induction therapy is associated with reduced rejection rates and improved death-censored graft survival.