The prognostic ability of zero hour biopsy (ZHB) in renal allografts has not been fully elucidated. ZHB utility predicting living kidney donor (LKD) renal recovery is unknown. Herein, we report a single center preliminary experience with ZHB in LKD transplants.

We analyzed all adult LKD and intended recipients between March 2017 and November 2017. LKD underwent thorough medical evaluation including a 24 hour creatinine clearance (24CrCl) >80 ml/min/m². All ZHB were pre-implantation by multifocal needle core; tissue was fixed and embedded in routine manner. Pathology was reported as either high risk (HR) or low risk (LR) based on presence of moderate tubular atrophy (TA) or arteriosclerosis (AS) and >10% glomerulosclerosis (GS) in the former. Renal function was examined in LKD pre-and post-donation, and recipients at discharge.

There were 12 LKD allografts with ZHB: 6 LR and 6 HR. Both groups had similar mean age (LR: 45±10 vs. HR: 52±10; p=0.24), females (LR: 66% vs. HR: 66%; p=ns), Caucasians (LR: 83% vs HR: 83%; p=ns) and kidney volumes (LR: 265±33 cc vs. HR: 266±24 cc; p=0.95). No donor was hypertensive. LR donors had lower pre-operative creatinine (LR: 0.7±0.1 vs. HR: 0.9±0.1; p<0.04) and eGFR (LR: 101±13 vs. HR: 78±9; p<0.04). Pre-donation 24CrCl was not different (LR: 108±28 vs. 119±13; p=0.5). Mean % GS in upper pole sample was higher in HR ZHB (LR: 3±3% vs. HR: 9±5%; p<0.04). 50% HR ZHB had moderate AS and 1 case had severe AS, contrasting with 83% of LR ZHB showing mild AS. To date, recipient and allograft survival remains 100%; recipient eGFR at discharge was similar in both ZHB groups (LR: 62±18 vs. HR: 56±16; p=0.58). However, HR ZHB donors had a lower eGFR on follow up (LR: 66±17 vs. HR: 44±2; p=0.02). Most importantly, all HR ZHB donors had an eGFR equivalent to CKD stage IIIa (50%) or IIIb (50%) at last follow up.

Our preliminary data suggest that 50% of LKD present unexpected chronic renal pathology, unforeseen by standard LKD selection practices. As transplant centers expand their living donor pool, ZHB may provide valuable assessment of LKD prognosis. HR ZHB donors could benefit from closer and longer monitoring due to increased risk of renal function deterioration.

CITATION INFORMATION: Nishio-Lucar A., Murphy J., Sites A., Cathro H., Doyle A., Warburton K., Agarwal A. Chronic Changes on Time Zero Living Donor Allograft Biopsy Portraits Worse Donor Renal Function Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress