Does Extended Criteria Donor Kidney Biopsy Predict Five-Year Patient and Graft Survival?
UCLA David Geffen School of Medicine, Los Angeles, CA
Meeting: 2013 American Transplant Congress
Abstract number: 539
Purpose: Donor biopsy is frequently used to assess extended criteria donor (ECD) organ quality, but the effect on patient survival and graft survival is less known. The objective of the study was to determine ECD biopsy characteristics predictive of 5-year patient and graft survival.
Methods: A retrospective review of kidney transplant outcomes and biopsy results from donors aged 50 and above from 2000-2010 was performed using data from a single organ procurement organization. Donors with multi-organ transplants, missing information, and kidneys discarded for other reasons than biopsy were excluded. Recipient data was obtained from an OPTN Standard Transplant Analysis and Research file for the same years. Biopsy results were categorized in 2 groups: 1) none, mild, mild-moderate; 2) moderate, moderate-severe, severe. Statistical analysis was performed using Cox regression. The multivariate analysis controlled for age, race and gender.
Results: Among 1691 biopsied kidneys from donors aged 50 and above, 1027 were transplanted and 664 (40%) were discarded. 900 transplanted kidneys were included in the analysis. The hazard ratios for the multivariate analysis are:
| Biopsy Variable | Hazard Ratio | p-value |
|---|---|---|
| GS | 2.28 | 0.011 |
| Interstitial Fibrosis | 1.39 | 0.324 |
| Tubular Atrophy | 2.29 | 0.413 |
| ATN | 2.51 | 0.119 |
| Atherosclerosis | 1.29 | 0.167 |
| Arteriolosclerosis | 0.91 | 0.973 |
| Biopsy Variable | Hazard Ratio | p-value |
|---|---|---|
| GS | 1.05 | 0.938 |
| Interstitial Fibrosis | 1.35 | 0.479 |
| Tubular Atrophy | 4.24 | 0.157 |
| ATN | 5.87 | 0.001 |
| Atherosclerosis | 1.54 | 0.051 |
| Arteriolosclerosis | 2.09 | 0.001 |
The degree of GS significantly decreases patient survival by a factor of 2, while it does not significantly affect graft survival. The recipient factor of age greater than 55 is associated with a 2.60 (p=0.001) fold decrease in patient survival, but this did not affect graft survival (0.84;p=0.457). Acute tubular necrosis (ATN), atherosclerosis, and arteriolosclerosis significantly decrease graft survival by a factor of 5.9, 1.5, and 2, but does not affect patient survival. Overall 5-year graft and patient survival is 65% and 75%.
Conclusions: The degree of GS does not predict graft failure, however the presence of ATN and vascular changes are predictive. Recipient factors may play a more important role in determining graft function. Many kidneys with marginal biopsy characteristic have acceptable graft and patient outcomes in the 5-year period.
To cite this abstract in AMA style:
Ng G, Faerstain S, Mehrnia A, Kamgar M, Bunnapradist S, Gritsch H. Does Extended Criteria Donor Kidney Biopsy Predict Five-Year Patient and Graft Survival? [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/does-extended-criteria-donor-kidney-biopsy-predict-five-year-patient-and-graft-survival/. Accessed November 23, 2024.« Back to 2013 American Transplant Congress