Implications of Living Kidney Donor Histology, Volume and Function on Allograft Outcome

S. Shah,¹ B. Lankowsky,² L. Herlitz,³ A. Chiesa-Vottero,³ Z. Zaky,¹ D. Goldfarb,⁴ S. Flechner,⁴ E. Poggio.¹

¹Nephrology, Cleveland Clinic, Cleveland, OH
²Case Western University SOM, Cleveland, OH
³Pathology, Cleveland Clinic, Cleveland, OH
⁴Urology, Cleveland Clinic, Cleveland, OH.

Meeting: 2015 American Transplant Congress

Abstract number: A44

Keywords: Graft function, Kidney transplantation

Session Information

Session Name: Poster Session A: Delayed Function/Acute Injury/Outcomes/Glomerulonephritis

Session Type: Poster Session

Date: Saturday, May 2, 2015

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Exhibit Hall E

Donor factors are determinants of donor quality and therefore graft function in deceased donation (DD). We hypothesized that analogous to DD, donor factors such as kidney function, histology and volume are also associated with graft outcomes in living kidney donation (LKD).

We studied 404 donor-recipient pairs. Implant biopsies were obtained in all donated kidneys. Histological changes studied included arteriosclerosis (AS), glomerulosclerosis (GS), interstitial fibrosis/tubular atrophy (IFTA) and were reported if greater than 5% involvement. Kidney volumes were calculated from CT scans and donor kidney function was measured by ¹²⁵I-iothalamate GFR (iGFR). Recipient GFR was calculated using the CKD-EPI equation. Primary outcome was graft function (eGFR >60 and < 60 ml/min/1.73 m²) at 12 months post-transplant. Univariable and multivariable logistic regression models were used to study associations between changes in implant biopsies, donor kidney volumes and function with recipient eGFR.

Donor age was 41±10 yo, 12.1% were AA and 60% were female. Donor iGFR was 107±16 ml/min/1.73 m² and donated kidney volume (adjusted for recipient's BSA) was 213±56 cc/1.73 m². Normal implant biopsies were present in 54% of the donors while the other 46% showed changes as follows: 38% had 1, 14% had 2 and 3% had 3 histological abnormalities. AS, GS and IFTA were present in 41%, 21% and 10% of biopsies respectively. Lower donor GFR and abnormal histology were statistically associated with older donor age (p<0.001 for both). Recipient age was 48±14 yo, 13% were AA and 36% were female. One-year eGFR >60ml/min/1.73m² was present in 41% of the recipients (mean eGFR of 56±17 ml/min/1.73 m²). The table illustrates the association of these variables with graft outcome. Both preoperative GFR and implant histology remained independently associated with recipient GFR in multivariate analysis.

Table 1
	Recipient eGFR (ml/min/1.73m²)
	eGFR < 60	eGFR > 60	P Value
Donor iGFR (ml/min/1.73m²)	104±15	110±17	<0.001
Abnormal Renal Histology(%)	66	34	0.012
Kidney Volume (cc/1.73m²)	196±60	198±58	NS

In conclusion, donor GFR and renal histology are independently associated with donor age and are determinants of recipient GFR.

To cite this abstract in AMA style:

Shah S, Lankowsky B, Herlitz L, Chiesa-Vottero A, Zaky Z, Goldfarb D, Flechner S, Poggio E. Implications of Living Kidney Donor Histology, Volume and Function on Allograft Outcome [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/implications-of-living-kidney-donor-histology-volume-and-function-on-allograft-outcome/. Accessed May 9, 2025.

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