Individual Histologic Lesions and Composite Scores in Implant Biopsies Affect Short-Term and Long-Term Kidney Allograft Function

Our aim was to evaluate which histologic lesions in a donor kidney were associated with graft function up to 5 years and with its dynamics. We retrospectively investigated the association between acute and chronic individual histologic lesions and composite scores in preimplant and postreperfusion biopsies from deceased-donor (n = 101) and living-donor (n = 29) kidneys with initial graft function and function at discharge, at 6 months, and at 5 years and slopes of estimated glomerular filtration rate from discharge to 6 months and from 6 months to 5 years. A high frequency of chronic and acute histologic lesions in donor kidneys is characteristic of our population of donors with high cardiovascular risk. Glomerulitis in preimplant biopsies predicted delayed graft function. Arteriolar hyalinosis predicted impaired initial graft function. Arteriolar hyalinosis and arteriosclerosis both predicted lower estimated glomerular filtration rate at discharge and ≥ 25% drop in function after 6 months. Glomerulosclerosis affected the estimated glomerular filtration rate at discharge and at 6 months; percentage of changed glomeruli predicted lower function at discharge and at 5 years. Glomerular thrombi in preimplant and postreperfusion biopsies predicted negative slope in estimated glomerular filtration rate from discharge to 6 months and a ≥ 25% drop in function after 6 months, respectively. Fibrinoid necrosis in glomeruli in preimplant biopsies predicted decline in function of ≥ 5 mL/min/1.73m² every year after 6 months. Chronic and total preimplant and posttransplant Banff scores predicted lower estimated glomerular filtration rate at discharge and at 6 months, with ≥ 25% drop in function after 6 months. Intraoperative biopsies are important in identifying patients at risk for worse graft function, especially concerning absence of gain of function early after transplant and loss of function late after transplant.