Time-Zero Biopsies in Deceased-Donor Kidney Transplantation: Predictive Value of Histological Findings on Long-Term Graft Function
Background: Time-zero biopsies (TzB) provide insights into donor-derived lesions, but their predictive value for long-term outcomes remains uncertain. We aimed to identify clinical and histological factors from TzB of deceased donors influencing glomerular filtration rate (GFR) at 3- and 5-year po...
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Associação Brasileira de Transplante de Órgãos
2025-02-01
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| Series: | Brazilian Journal of Transplantation |
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| Online Access: | https://bjt.emnuvens.com.br/revista/article/view/638 |
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| author | Bárbara Beirão Henrique Borges Joana Trigo Medeiros Filipa Fonte Rodrigues Ana Pena Mário Góis Helena Viana Cristina Jorge |
| author_facet | Bárbara Beirão Henrique Borges Joana Trigo Medeiros Filipa Fonte Rodrigues Ana Pena Mário Góis Helena Viana Cristina Jorge |
| author_sort | Bárbara Beirão |
| collection | DOAJ |
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Background: Time-zero biopsies (TzB) provide insights into donor-derived lesions, but their predictive value for long-term outcomes remains uncertain. We aimed to identify clinical and histological factors from TzB of deceased donors influencing glomerular filtration rate (GFR) at 3- and 5-year post-transplantation. Methods: We retrospectively analyzed TzB performed from January 2015 to August 2019. Nineteen biopsies were excluded due to recipient death before 3 years. We examined donor and recipient-related characteristics and histological findings categorized using the Banff scoring system. Results: Among 147 biopsies, 61.9% of donors were male, with a mean age of 51.8 ± 13.5 years, and 27.2% met expanded criteria. Histologic analysis revealed 44.2% had alterations in the Banff chronic scoring system: 29.1% in vascular fibrous intimal thickening (Cv), 26.6% in arteriolar hyalinosis (Ah), and 8.3% in interstitial fibrosis (Ci)/tubular atrophy (Ct). Mean GFR was 54.8 ± 21.2 and 52.3 ± 23.0 mL/min/1.73 m2 at 3 and 5 years, respectively. At 3 years, Ah > 0, Ci/Ct > 0, Cv > 0, Banff chronic sum score > 0, glomerulosclerosis (GE), donor age > 50 years, expanded criteria donors, and rejection episodes were significantly associated with lower GFR. With the exception of Ci/Ct, all other parameters were also significantly associated with lower GFR at 5 years. Linear regression indicated donor age [β (95%CI) = -0.257 (-0.783, -0.021); p = 0.039] and arteriolar hyalinosis [β (95%CI) = -0.207 (-16.767, -0.448); p = 0.039]; p = 0.039) as predictors of GFR at 3 years, with donor age maintaining predictive value at 5 years [β (95%CI) = -0.276 (-0.776, -0.137); p = 0.006]. A tendency towards predictive value for GFR at 5 years was noted for GE [β (95%CI) = -0.198 (120.0, 1.038); p = 0.054]. Conclusion: TzB provide valuable prognostic information for long-term graft function with histological findings (particularly arteriolar hyalinosis and GE) and donor age serving as significant predictors of GFR at 3 and 5 years post-transplantation. These findings suggest TzB can be useful for risk stratification and personalized management of KT recipients.
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| format | Article |
| id | doaj-art-0aa18eed7d7c4efb99e6a2e8c5b4a5b0 |
| institution | Kabale University |
| issn | 2764-1589 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Associação Brasileira de Transplante de Órgãos |
| record_format | Article |
| series | Brazilian Journal of Transplantation |
| spelling | doaj-art-0aa18eed7d7c4efb99e6a2e8c5b4a5b02025-02-03T20:25:46ZengAssociação Brasileira de Transplante de ÓrgãosBrazilian Journal of Transplantation2764-15892025-02-0128Time-Zero Biopsies in Deceased-Donor Kidney Transplantation: Predictive Value of Histological Findings on Long-Term Graft FunctionBárbara Beirão0Henrique Borges1Joana Trigo Medeiros 2Filipa Fonte Rodrigues 3Ana Pena4Mário Góis5Helena Viana6Cristina Jorge 7Unidade Local de Saúde de Trás-os-Montes e Alto Douro – Serviço de Nefrologia – Vila Real – Portugal.Unidade Local de Saúde do Algarve – Serviço de Nefrologia – Faro – Portugal.Unidade Local de Saúde de Braga – Serviço de Nefrologia – Braga – Portugal.Unidade Local de Saúde de Almada-Seixal – Serviço de Nefrologia – Almada – Portugal.Unidade Local de Saúde de São José – Serviço de Nefrologia – Lisboa – Portugal.Unidade Local de Saúde de São José – Serviço de Nefrologia – Lisboa – Portugal.Unidade Local de Saúde de São José – Serviço de Nefrologia – Lisboa – Portugal.Unidade Local de Saúde de São José – Serviço de Nefrologia – Lisboa – Portugal. Background: Time-zero biopsies (TzB) provide insights into donor-derived lesions, but their predictive value for long-term outcomes remains uncertain. We aimed to identify clinical and histological factors from TzB of deceased donors influencing glomerular filtration rate (GFR) at 3- and 5-year post-transplantation. Methods: We retrospectively analyzed TzB performed from January 2015 to August 2019. Nineteen biopsies were excluded due to recipient death before 3 years. We examined donor and recipient-related characteristics and histological findings categorized using the Banff scoring system. Results: Among 147 biopsies, 61.9% of donors were male, with a mean age of 51.8 ± 13.5 years, and 27.2% met expanded criteria. Histologic analysis revealed 44.2% had alterations in the Banff chronic scoring system: 29.1% in vascular fibrous intimal thickening (Cv), 26.6% in arteriolar hyalinosis (Ah), and 8.3% in interstitial fibrosis (Ci)/tubular atrophy (Ct). Mean GFR was 54.8 ± 21.2 and 52.3 ± 23.0 mL/min/1.73 m2 at 3 and 5 years, respectively. At 3 years, Ah > 0, Ci/Ct > 0, Cv > 0, Banff chronic sum score > 0, glomerulosclerosis (GE), donor age > 50 years, expanded criteria donors, and rejection episodes were significantly associated with lower GFR. With the exception of Ci/Ct, all other parameters were also significantly associated with lower GFR at 5 years. Linear regression indicated donor age [β (95%CI) = -0.257 (-0.783, -0.021); p = 0.039] and arteriolar hyalinosis [β (95%CI) = -0.207 (-16.767, -0.448); p = 0.039]; p = 0.039) as predictors of GFR at 3 years, with donor age maintaining predictive value at 5 years [β (95%CI) = -0.276 (-0.776, -0.137); p = 0.006]. A tendency towards predictive value for GFR at 5 years was noted for GE [β (95%CI) = -0.198 (120.0, 1.038); p = 0.054]. Conclusion: TzB provide valuable prognostic information for long-term graft function with histological findings (particularly arteriolar hyalinosis and GE) and donor age serving as significant predictors of GFR at 3 and 5 years post-transplantation. These findings suggest TzB can be useful for risk stratification and personalized management of KT recipients. https://bjt.emnuvens.com.br/revista/article/view/638Renal Transplantation |
| spellingShingle | Bárbara Beirão Henrique Borges Joana Trigo Medeiros Filipa Fonte Rodrigues Ana Pena Mário Góis Helena Viana Cristina Jorge Time-Zero Biopsies in Deceased-Donor Kidney Transplantation: Predictive Value of Histological Findings on Long-Term Graft Function Brazilian Journal of Transplantation Renal Transplantation |
| title | Time-Zero Biopsies in Deceased-Donor Kidney Transplantation: Predictive Value of Histological Findings on Long-Term Graft Function |
| title_full | Time-Zero Biopsies in Deceased-Donor Kidney Transplantation: Predictive Value of Histological Findings on Long-Term Graft Function |
| title_fullStr | Time-Zero Biopsies in Deceased-Donor Kidney Transplantation: Predictive Value of Histological Findings on Long-Term Graft Function |
| title_full_unstemmed | Time-Zero Biopsies in Deceased-Donor Kidney Transplantation: Predictive Value of Histological Findings on Long-Term Graft Function |
| title_short | Time-Zero Biopsies in Deceased-Donor Kidney Transplantation: Predictive Value of Histological Findings on Long-Term Graft Function |
| title_sort | time zero biopsies in deceased donor kidney transplantation predictive value of histological findings on long term graft function |
| topic | Renal Transplantation |
| url | https://bjt.emnuvens.com.br/revista/article/view/638 |
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