*Purpose: The data on outcomes of focal CN in PBx after deceased donor transplantation is sparse. We studied the prognostic value of focal CN on PBx on graft survival, GFR and 1 year protocol biopsy after deceased donor kidney transplantation.

*Methods: Patients who received deceased donor kidney transplant at our center between 1/2013 and 8/2018 were included. We obtained the pathology data from all PBx reports read at our center. Cortical necrosis was reported as none [control group], focal (<10%involvement) [study group] or diffuse (>10%)[which is a contraindication at our center for transplanting]. We excluded diffuse CN. Acute Kidney Injury Network (AKIN) criteria were used to classify the donors. Graft survival, delayed graft function, GFR at 1 yr and protocol biopsy findings at 1 yr for chronic changes, namely percent glomerulosclerosis (GS%), interstitial fibrosis (ci), and tubular atrophy (ct) was compared between the two groups.

*Results: Of the 1,198 patients transplanted, PBX with CN data was available in 679 donors. No CN was seen in 594, focal CN in 84 donors and diffuse CN in 1(excluded). Presence of focal CN correlated well with donor AKIN grade (fig. 1). The mean KDPI in donors with focal CN was lower when compared to donors without CN [48.7 (SD 24.6) vs 60.7(SD 24.1), p <0.0001]. Focal CN was strongly associated with delayed graft function (p=0.002). Outcomes in terms of graft survival (fig.2), GFR at 1 yr, biopsy findings at 1 yr for chronic changes were similar between both the groups as shown in the table. GS % was lower in donors with focal CN (p=0.01)

*Conclusions: Focal CN on PBx correlates well with donor AKIN stage and DGF. However, no significant difference was found in the graft survival or outcomes at 1 year with regards to chronic changes on protocol biopsy or in GFR. Focal CN on preimplantation biopsies should not be a sole criterion for organ discard.

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