*Purpose: The kidney donor profile index (KDPI) includes donor factors that are associated with graft survival, and estimates the quality of the kidney graft. Suboptimal findings in post-transplant reperfusion biopsy are associated with shorter kidney graft survival. Our objective was to determine, whether KDPI correlates with the findings of the reperfusion biopsy.

*Methods: Out of 231 records of patients who received deceased kidney transplant at our institution between 2013-2017, we selected only those containing results of pathological findings on post-transplant reperfusion biopsy (n=51). After excluding multiorgan and pediatric transplants, we analyzed the following components of the kidney biopsy: interstitial fibrosis, tubular atrophy, arteriolosclerosis and arteriolar hyalinosis, all expressed as none, mild, moderate or severe. Presence or absence of ATN was also analyzed. Among those 51 records with reperfusion biopsy results, we found 31 pre transplant procurement biopsy in the UNET portal including them into the analysis. Kidney graft function was assessed based on serum Cr at 1, 3, 6 and 12 months post transplant. We used Spearman’s correlation and exact Fisher’s test, p<0.05 was considered significant.

*Results: All procurement biopsy results presented none or minimal pathologic changes besides ATN, which varied from none to severe. KDPI was in wide range from 3 to 93 with median value of 61. KDPI significantly correlated with all the different components of the pathological findings in reperfusion biopsy: interstitial fibrosis (r=0.36, p=0.008), tubular atrophy (r=0.36, p=0.008), arteriosclerosis (r=0.48, p<=0.001) and arteriolar hyalinosis (r=0.48, p=0.001). Degree of arteriolosclerosis and arteriolar hyalinosis correlated with serum Cr at 6 (r=0.36, p=0.012; r=0.35, p=0.017) and 12 months (r=0.30, p=0.041; r=0.33, p=0.032) but not at earlier time points. Interstitial fibrosis and tubular atrophy did not correlate with graft function within one year. Presence of acute tubular necrosis (ATN) in procurement biopsy but not in reperfusion biopsy correlated with higher Cr at 1 month (r=0.43, p=0.01). As expected, the KDPI had a positive correlation with Cr at 1, 6 and 12 months (r=0.36, p=0.007;r=0.43, p=0.002; r=0.43, p=0.003, respectively).

*Conclusions: In this study, the KDPI correlated with the degree of interstitial fibrosis, tubular atrophy, arteriolosclerosis and arteriolar hyalinosis on reperfusion biopsy, as well as with graft function within the first year post transplant. Vascular changes in reperfusion biopsy (arteriolosclerosis and arteriolar hyalinosis) are the most prognostic indicators of graft function within one year post transplantation.

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