Background

A significant number of kidneys are discarded worldwide due to the suboptimal use of large kidney resources. The mean cause is the result of the preimplantation biopsy without clear evidence that its results are associated with long-term allograft survival.

Methods

We included patients who underwent kidney transplantation from a deceased donor in 2 French referral centers between January 1, 2004 and January 1, 2011 where preimplantations are routinely performed and graded by nephro-pathologists. All the patients with a preimplantation biopsy were included. A systematic assessment of donor, recipient, and transplant clinical characteristics, of the preimplantation biopsy and an evaluation of baseline circulating donor-specific anti-HLA antibody (DSA) levels were performed.

Results: A total of 882 patients were included in the study. A total of 352/882 (40%) transplantations were performed using ECD kidneys and a total of 143/882 (16%) had an anti-HLA DSA at the day of transplantation. The mean recipient age was 49.98 ± 13.08 years. The mean follow-up time after transplantation was 6.56 ± 2.37 years. After adjusting for donor, recipient, and transplant characteristics as well as for preimplantation biopsy findings (including the atrophy-fibrosis (IFTA), percentage of sclerotic glomeruli, arteriosclerosis (cv Banff score) and arteriolar hyalinosis scores (ah Banff score) and baseline immunological parameters, we identified the KDRI score (hazard ratio (HR)=2.17; 95% confidence interval (CI), (1.31 to 3.46); p=0.002) and the presence of circulating anti-HLA DSA at the day of transplantation (HR=2.89; 95% CI, (1.95 to 4.27); p<0.0001) as the main independent determinants of long-term allograft loss. None of the preimplantation biopsy findings showed independent association with the kidney allograft survival.

Conclusions

Preimplantation biopsy assessment does not provide independent and additional predictive ability for long-term allograft outcome at a population level in deceased donor programs. The current practice of discarding kidneys based on preimplantation biopsy findings may not be optimal for decision-making and is a barrier to increase the supply of kidney transplants.

CITATION INFORMATION: Aubert O, Viglietti D, Loheac C, Rabant M, Gosset C, Duong Van Huyen J, Glotz D, Legendre C, Lefaucheur C, Loupy A. Absence of Independent and Additional Predictive Ability of Preimplantation Kidney Allograft Biopsies for Long-Term Outcome: Population Based Study. Am J Transplant. 2017;17 (suppl 3).

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