Background: Kidney Donor Profile Index (KDPI) is a numerical estimate of deceased donor kidney quality that uses 10 donor factors but does not consider histopathologic findings. We examined whether KDPI and its component donor factors correlate with the degree of histopathologic changes seen in implantation renal allograft biopsies. Methods: All deceased donor kidney transplants at our institution from 07/01/2016 to 03/15/2017 that had an implantation biopsy were included. The biopsies were graded based on Banff criteria for interstitial fibrosis, tubular atrophy, arterial intimal fibrosis, and arteriolar hyalinosis, as well as percent glomerulosclerosis. Linear and logistic regression were used to assess correlation between histopathologic findings and KDPI and the ability of these variables to predict 30-day serum creatinine and delayed graft function (DGF). Results: 134 recipients from 107 donors were included. All histopathologic features examined significantly correlated with KDPI, with arteriolar hyalinosis correlating most strongly. Arteriolar hyalinosis was also associated with the most component donor factors of KDPI. Histopathologic findings alone or in combination with KDPI predicted 30-day serum creatinine but not DGF. Using KDPI in combination with degree of interstitial fibrosis and tubular atrophy was the best predictor of 30-day serum creatinine. Conclusion: Histopathologic changes seen in implantation renal allograft biopsies correlate with KDPI and predict 30-day serum creatinine. Using a combination of donor histopathologic findings and KDPI may be the best predictors of short-term graft function.

months. In multivariate linear regression, BMI-Z at transplant and >12 months spent on dialysis were both significant predictors of ΔBMI-Z at 12 months post transplant (p<0.001 and p=0.006) and 24 months post transplant (p<0.001 and p=0.034). No othr patient or treatment related variables were found to significantly predict weight gain. Conclusions: Dramatic and excessive weight gain was seen following transplant to the extent that 50% of paediatric kidney transplant recipients were overweight or obese at 1 year after transplant. While increased weight gain was seen in recipients with a lower BMI at transplant and those who had spent less time on dialysis, the risk of being overweight or obese should be considered and managed for all paediatric recipients of kidney transplants.