Living Kidney Donor Time Zero Biopsy Findings Predict Graft Loss in the Recipient

N. Issa¹, C. Lopez¹, A. Denic¹, J. J. Larson¹, R. Narasimhan¹, L. Archila¹, S. S. Taler¹, H. Chakkera², J. Augustine³, M. Stegall⁴, A. Rule¹

¹Nephrology, Mayo Clinic, Rochester, MN, ²Nephrology, Mayo Clinic, Phoenix, AZ, ³Nephrology, Cleveland Clinic, Cleveland, OH, ⁴Transplantation, Mayo Clinic, Rochester, MN

Meeting: 2019 American Transplant Congress

Abstract number: C60

Keywords: Graft failure, Histology, Kidney transplantation, Outcome

Session Information

Session Name: Poster Session C: Kidney Complications: Late Graft Failure

Session Type: Poster Session

Date: Monday, June 3, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: Recipient outcomes with living donor kidney grafts are superior to those achieved from deceased donors. However, there may still be variability in the quality of grafts from living kidney donors. The time-zero biopsy of living donor kidneys may detect this variability in quality.

*Methods: In an effort to identify the donor biopsy findings that portend a higher risk for poor outcome in the recipient, we studied donor biopsy structural measures as predictors of death-censored graft loss in 2321 living kidney donor-recipient pairs. Clinical donor characteristics included donor age, race/ethnicity, BMI, albuminuria, HTN, and measured GFR. Nephron size was measured by glomerular volume, cortex volume per glomerulus, and mean cross-sectional tubular area. Nephrosclerosis was defined by age-specific thresholds for global glomerulosclerosis, interstitial fibrosis/tubular atrophy (IF/TA), and arteriosclerosis. Nephron number was estimated from CT scan and biopsy measures.

*Results: Among clinical predictors, older donor age (HR, 1.12 per 10 years [95% CI, 1.00 to 1.25]; p=0.05) and donor urinary albumin (HR, 1.11 per doubling [95% CI, 1.02 to 1.21]; p=0.01) predicted long-term graft loss. Using a multivariate model, and after adjustments for all other donor biopsy and CT variables, cortical fibrosis (HR, 3.01 for ≥5% vs. 0% [95% CI, 1.34 to 6.74]; p=0.008) and larger profile tubular area (HR, 1.09 per 1000µm² [95% CI, 1.00 to 1.18]; p=0.05) were independent predictors of death-censored graft loss. After further adjustments for recipients (including basic demographics, kidney disease cause, HLA-mismatches, dialysis time, DGF, and induction/maintenance immunosuppression) and donors covariates, cortical fibrosis, glomerular volume and larger profile tubular area as well as IF/TA on time-zero biopsies remained predictors of death-censored graft loss.

*Conclusions: In this multicenter cohort independent of donor clinical characteristics, larger nephron size and greater nephrosclerosis predict graft loss in the recipient. Our data suggest that assessment of living donor kidney biopsy structural characteristics could supplement the consideration of clinical donor and recipient characteristics in predicting post-transplant risk of graft failure.

To cite this abstract in AMA style:

Issa N, Lopez C, Denic A, Larson JJ, Narasimhan R, Archila L, Taler SS, Chakkera H, Augustine J, Stegall M, Rule A. Living Kidney Donor Time Zero Biopsy Findings Predict Graft Loss in the Recipient [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/living-kidney-donor-time-zero-biopsy-findings-predict-graft-loss-in-the-recipient/. Accessed May 18, 2025.

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