Using Implantation Biopsies as a Surrogate to Evaluate Selection Criteria for Living Kidney Donors

Chauhan, Ashutosh; Diwan, Tayyab S.; Palacios, Carlos R. Franco; Dean, Patrick G.; Heimbach, Julie K.; Chow, George K.; Prieto, Mikel; Cosio, Fernando G.; Taler, Sandra J.; Textor, Stephen C.; Kudva, Yogish C.; Cornell, Lynn D.; Stegall, Mark D.

doi:10.1097/tp.0b013e3182a2b455

Cited by 15 publications

(20 citation statements)

References 15 publications

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“…12 However, our findings are in contrast with the findings of Chauhan et al, 8 Choi et al, 9 and Elsherbiny et al 14 This difference could arise due to several reasons, including our longer follow-up time, differences in patient casemix, covariate adjustment, our robust statistical methods to account for the correlated nature of the longitudinal data (multiple eGFR measurements per donor), and/or the types of histological abnormalities studied and their cut-offs.…”

Section: Discussioncontrasting

confidence: 94%

“…Indeed, 4–50% of implantation biopsies have been found to harbor moderate-to-severe histological abnormalities. 8–13 However, there are conflicting reports about the association between these histological abnormalities and postdonation renal function (estimated glomerular filtration rate, eGFR) in living kidney donors. 8–10,12,14 …”

Section: Introductionmentioning

confidence: 99%

“…The studies that found no association between histological abnormalities and postdonation renal function were notable for insufficient follow-up (<1 year) for the evolution of clinically salient CKD. 8,9 Also, no study to date, to our knowledge, has accounted for the hierarchical structure of eGFR data (repeated measurements of eGFR for an individual); as such, even the significant association found in some studies might represent statistical artifacts.…”

Section: Introductionmentioning

confidence: 99%

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Long-term Renal Function in Living Kidney Donors Who Had Histological Abnormalities at Donation

Fahmy¹,

Massie²,

Muzaale³

et al. 2016

Transplantation

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Background Recent evidence suggests that living kidney donors are at an increased risk of end-stage renal disease. However, predicting which donors will have renal dysfunction remains challenging, particularly among those with no clinical evidence of disease at the time of donation. Although renal biopsies are not routinely performed as part of the donor evaluation process, they may yield valuable information that improves the ability to predict renal function in donors. Methods We used implantation protocol biopsies to evaluate the association between histological abnormalities in the donated kidney and postdonation renal function (estimated glomerular filtration rate, eGFR) of the remaining kidney in living kidney donors. Longitudinal analysis using mixed-effects linear regression was used to account for multiple eGFR measures per donor. Results Among 310 donors between 1997 and 2012, median (IQR) follow-up was 6.2 (2.5–8.7; maximum 14.0) years. In this cohort, the overall prevalence of histological abnormalities was 65.8% (19.7% abnormal glomerulosclerosis, 23.9% abnormal interstitial fibrosis and tubular atrophy (IFTA), 4.8% abnormal mesangial matrix increase, 32.0% abnormal arteriolar hyalinosis, and 32.9% abnormal vascular intimal thickening). IFTA was associated with a 5-mL/min/1.73m2 decrease of postdonation eGFR after adjusting for donor age at donation, sex, race, preoperative systolic blood pressure, preoperative eGFR, and time since donation (p<0.01). Conclusions In this single-center study, among healthy individuals cleared for living donation, IFTA was associated with decreased postdonation eGFR, while no other subclinical histological abnormalities provided additional information.

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Section: Discussioncontrasting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term Renal Function in Living Kidney Donors Who Had Histological Abnormalities at Donation

Fahmy¹,

Massie²,

Muzaale³

et al. 2016

Transplantation

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“…Indeed, previous studies have shown a high prevalence of vascular disease in living kidney donors, as manifested by vascular fibrous intimal thickening and arteriolar hyaline thickening seen in over a third of the pre-implantation biopsies [14,15]. Additionally, increasing donor age was shown to be strongly correlated with the presence and severity of vascular disease [14,16]. Vascular disease in the donor biopsy specimen was also correlated with chronic intimal thickening and arteriolar hyalinosis score of the allograft at 3-month protocol biopsy [17].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of abdominal aortic calcifications in older living renal donors and its effect on graft function and histology

Wu¹,

Wojciechowski

Chandran

et al. 2015

Transpl Int

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SummaryWe assessed the prevalence of abdominal aortic calcification (AAC) in older living kidney donors and its effect on recipient eGFR and graft histology. A total of 292 consecutive living pairs with donor age ≥50 from 2003 to 2013 were identified (mean age 56; range 50-78; F/M: 1.8). Donor AAC was determined by prenephrectomy unenhanced CT. Recipient eGFR and spot urine protein: creatinine ratios (UPCRs) were recorded. A total of 180 recipients had 6-month protocol biopsies. AAC was present in 40.7% of donors, and they were older (58.6 versus 54.7 years old, P < 0.0001) and more likely to be male (77.6% vs. 37.3%, P = 0.004). There was no significant difference in eGFR or spot UPCR up to 36 months in recipients of allografts from donors with versus without AAC. At 6-month biopsy, there was a higher percentage of allografts with vascular fibrous intimal thickening and arteriolar hyaline thickening from donors with versus without AAC (vascular fibrous intimal thickening: 38.8% vs. 7.1% and arteriolar hyaline thickening: 35.8% vs. 7.1%; P < 0.001 for both). The presence of donor AAC predicts the presence of vascular disease [vascular fibrous intimal thickening (OR: 7.2; CI:2.9-17.9) and arteriolar hyaline thickening (OR:5.7; CI:2.3-14.1)] in allografts at 6 months. Donor AAC is predictive of renal vascular disease and may help to improve the screening of potential donors and inform post-transplant management.

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“…Furthermore, history of hypertension and older age were independently associated with higher globally sclerotic glomerular density. In a similar analysis of the same cohort, Chauban et al showed that the prevalence of moderate-to-severe chronic histologic changes in donors was found in 4.1 % of the donors and that this prevalence was higher in donors aged older than 60 years compared with younger donors (11 % vs 3.5 %, p<0.001) and in donors with systolic blood pressure of 140 mmHg or greater when compared with normotensive donors (12 % vs 5.7 %, p=0.01) [47]. Short-term follow up in this study (4 months) showed no difference in post-nephrectomy GFR in any particular group.…”

Section: Kidney Histology In Living Donorsmentioning

confidence: 99%

Evaluation of Kidney Function and Structure in Potential Living Kidney Donors: Implications for the Donor and Recipient

2015

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Kidney transplantation is the best treatment for patients with end-stage renal disease and recipients of living kidney donors fare better than recipients of deceased donors. In view of the shortage of organ supply and the long waiting list, expansion of the living donor pool has been sought. Importantly, donor acceptance criteria must first and foremost be grounded in concerns for donor safety. Recent studies suggesting that live kidney donors may have higher rates of end-stage renal disease in the long term compared with otherwise similar healthy persons highlights the critical importance of pre-donation evaluation of renal function and structure, and careful application in donor selection criteria. The quality of organs from living donors may also affect recipient outcomes. Because donor kidney function, histology, and anatomy pertain to the quality of the donated organ, living donor characterization of the factors associated with these features is important to the donor as well as the recipient.

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Using Implantation Biopsies as a Surrogate to Evaluate Selection Criteria for Living Kidney Donors

Abstract: MSC occurred sporadically in donors with varied characteristics. Although we did not detect patterns to support specific changes in our acceptance criteria, certain subgroups of donors might benefit from close follow-up.

Cited by 15 publications

References 15 publications

Long-term Renal Function in Living Kidney Donors Who Had Histological Abnormalities at Donation

Long-term Renal Function in Living Kidney Donors Who Had Histological Abnormalities at Donation

Prevalence of abdominal aortic calcifications in older living renal donors and its effect on graft function and histology

Evaluation of Kidney Function and Structure in Potential Living Kidney Donors: Implications for the Donor and Recipient

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