*Purpose: The outcome of kidney transplantation is highly affected by donor category. Little is known about molecular processes which may underline this phenomenon.

*Methods: Using Molecular Microscope Diagnostic System (MMDx) we evaluated molecular scores in early indication biopsies (median 13 POD) diagnosed as Banff borderline category and subsequent 3M follow-up biopsies in three cohorts: expanded criteria donor (ECD, n=22), standard criteria donor (SCD, n=12) and living donor (LD, n=12) cohorts.

*Results: Compared to LD, both ECD and SCD kidney grafts exhibited higher acute kidney injury (AKI) score in early indication biopsies (p=0.012 and p=0.022, respectively). At 3-month follow-up biopsies the AKI was similar between ECD and SCD kidney grafts and decreased in both ECD (p=0.019) and SCD (p=0.015) in comparison to early biopsies. Similarly, higher atrophy-fibrosis scores in indication biopsies were found in both ECD (p=0.012) and SCD (p=0.004) as compared to LD kidney grafts. At 3-month follow-up biopsies the atrophy-fibrosis score increased in all donor categories (ECD, p=0.086; SCD, p=0.054; LD, p=0.027), in comparison with early biopsies while the differences among categories persisted (Fig 1). Donor categories had no effect neither on inflammation score nor rejection scores in both indication and follow-up biopsies.

Figure 1. MMDx scores A. Acute kidney injury score B. Atrophy-fibrosis score C. Inflammation score in early indication biopsy and follow-up 3-months biopsy in particular donor subcategories.

*Conclusions: MMDx acute kidney injury score reflects donor quality in early biopsies and resolved within 3 months. Interestingly, atrophy-fibrosis score deteriorated in all donor categories, living donor included, which pointed out to non-reversible changes induced by peritransplant injuries regardless the cold ischemia time.

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