Time-Zero Renal Biopsy in Living Kidney Transplantation: A Valuable Opportunity to Correlate Predonation Clinical Data With Histological Abnormalities

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Abstract

Background.

Living kidney donation is increasing as a partial solution for wait-listed patients. Despite properly followed guideline criteria for donor selection, current reports identify unsuspected renal pathology at preimplantation or time-zero biopsy (T0-RBx).

Methods.

T0-RBx was evaluated for following: interstitial fibrosis (IF), tubular atrophy (TA), arteriolar hyalinosis (AH), mesangial increase (MI), and glomerulosclerosis (GS). Predonation data were demography, body weight, body mass index (BMI), systolic/diastolic blood pressure (BP), serum creatinine (SCr), estimated glomerular filtration rate (eGFR), and proteinuria.

Results.

Two hundred nineteen T0-RBx were analyzed. Of these 54.4% had abnormal findings, namely, IF in 29%, TA in 13%, MI in 12%, AH in 10%, and GS in 10%. Mean clinical data were as follows: age 35.4±10 years, weight 66.27±10.14 kg, BMI 25.53±2.99, systolic BP 115±9 mm Hg, diastolic BP 74±7 mm Hg, SCr 0.91±0.25 mg/dL, eGFR 96±16.65 mL/min, and proteinuria 70.25±62.8 mg/24 hr. A total of 56.7% were women. IF correlated to age (r=0.22, P=0.001) and SCr (r=0.19, P=0.005); TA to diastolic BP (r=0.15, P=0.03) and proteinuria (r=0.20, P=0.009); AH to SCr (r=0.15, P=0.02) and eGFR (r=−0.16, P=0.018); MI to BMI (r=0.13, P=0.047). Multivariate analysis failed to sustain the significant associations found on bivariate analysis, most likely due to a low event/parameter relation and sample size.

Conclusions.

A significant correlation was established between T0-RBx findings and clinical predonation parameters. Whether these mild histologic findings at the time of kidney donation represent a higher risk for the remaining kidney ought to be evaluated during follow-up. In an era, when living kidney donation is increasing, we advise closer donor surveillance to modify risk factors that participate in kidney damage progression.

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