Procurement Kidney Biopsy and Donor Clinical Risk as Complementary Tools to Predict 3- and 12-Month Graft Function...

Area of Science:

• Nephrology
• Transplant Surgery
• Pathology

Background:

• Procurement kidney biopsies are used to assess donor kidney viability.
• Their role in predicting post-transplant graft function remains debated.
• This study evaluates the predictive performance of procurement biopsies for early kidney graft function.

Purpose of the Study:

• To assess the utility of procurement kidney biopsies in predicting graft function within the first year post-transplantation.
• To identify histological features and clinical parameters associated with early graft dysfunction.
• To evaluate the combined predictive performance of histological scoring and donor characteristics.

Main Methods:

• Retrospective cohort study of 339 kidney procurement biopsies.
• Biopsies were scored using Banff, Remuzzi, and MAPI classifications.
• Logistic regression analyzed associations between histology, KDPI, and graft function (eGFR <30 mL/min/1.73 m² at 3 and 12 months).

Main Results:

• Global glomerulosclerosis, Remuzzi score (4-6), and KDPI were associated with lower 3-month eGFR.
• Cortical scarring, Remuzzi scores (4-6, 7-12), and KDPI were associated with lower 12-month eGFR.
• The combination of Remuzzi score and KDPI showed the highest predictive performance (AU-ROC 0.760-0.762).

Conclusions:

• Histological findings in procurement biopsies are significantly associated with 3- and 12-month kidney graft function.
• Procurement biopsies, when combined with clinical parameters like KDPI, enhance risk stratification for kidney transplant recipients.
• These findings support the clinical utility of procurement biopsies in guiding graft acceptance and allocation decisions.