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Stent placement resulted in fewer cases of restenosis compared with angioplasty alone, although no benefit in terms of serum creatinine, blood pressure, or patient and graft survival was shown.

Background. Limited data are available on whether donor kidneys with diffuse glomerular fibrin thrombi (GFT) are safe to use. In this study, the clinicopathologic characteristics of allografts with diffuse donor-derived GFT were examined. Methods. All deceased donor kidney transplant implantation biopsies from our institution between July 2011 and February 2018 with diffuse GFT were included. A control group for comparison consisted of all cases with implantation biopsies obtained during the study period without diffuse GFT. Clinical data were extracted from electronic medical records for all study patients, including donor information. Results. Twenty-four recipients received kidneys with diffuse GFT from 16 deceased donors. All donors died from severe head trauma. On average, 79% of glomeruli contained fibrin thrombi. Nineteen cases had subsequent biopsy; all revealed resolution of GFT. Compared with the control group, kidneys with diffuse GFT had longer cold ischemia time (34 versus 27 h), were more frequently pumped using machine perfusion (100% versus 81%), and recipients experienced a higher frequency of delayed graft function (58% versus 27%). Only 2 grafts with diffuse GFT failed within the first year. Overall graft survival was similar between the diffuse GFT group and control group. Conclusions. Deceased donor kidneys with diffuse GFT appear to be safe to use given that nearly 92% of recipients in this cohort who received such allografts experienced good clinical outcomes. Histologically, GFT demonstrated rapid resolution following transplantation. Interestingly, diffuse GFT only occurred in donors who suffered severe head trauma in this cohort, which may be a predisposing factor.

Background: Kidney Donor Profile Index (KDPI) is a numerical estimate of deceased donor kidney quality that uses 10 donor factors but does not consider histopathologic findings. We examined whether KDPI and its component donor factors correlate with the degree of histopathologic changes seen in implantation renal allograft biopsies. Methods: All deceased donor kidney transplants at our institution from 07/01/2016 to 03/15/2017 that had an implantation biopsy were included. The biopsies were graded based on Banff criteria for interstitial fibrosis, tubular atrophy, arterial intimal fibrosis, and arteriolar hyalinosis, as well as percent glomerulosclerosis. Linear and logistic regression were used to assess correlation between histopathologic findings and KDPI and the ability of these variables to predict 30-day serum creatinine and delayed graft function (DGF). Results: 134 recipients from 107 donors were included. All histopathologic features examined significantly correlated with KDPI, with arteriolar hyalinosis correlating most strongly. Arteriolar hyalinosis was also associated with the most component donor factors of KDPI. Histopathologic findings alone or in combination with KDPI predicted 30-day serum creatinine but not DGF. Using KDPI in combination with degree of interstitial fibrosis and tubular atrophy was the best predictor of 30-day serum creatinine. Conclusion: Histopathologic changes seen in implantation renal allograft biopsies correlate with KDPI and predict 30-day serum creatinine. Using a combination of donor histopathologic findings and KDPI may be the best predictors of short-term graft function.

Background We provide detailed analysis and outcomes in patients post‐kidney transplant (KT) developing ascites, which has never been categorically reported. Methods Ascites was identified by ICD9/10 codes and detailed chart review in patients post‐KT from 01/2004‐06/2019. The incidence of patient death and graft loss were determined per 100‐person‐years, and the incidence rate ratio was obtained. Results Of 3329 patients receiving KT, 83 (2.5%) patients had new‐onset ascites, of whom 58% were male, 21% blacks, and 29% whites. Seventy‐five percentage were on hemodialysis. Patients were maintained primarily on tacrolimus and mycophenolate for immunosuppression. Only 14% of patients with ascites had the appropriate diagnostic workup. There was a trend toward an increased mortality in patients with ascites (incidence rate ratio, IRR [95% CI]: 1.8 [0.92, 3.19], p = .06), and a significantly higher incidence of graft loss (IRR: 5.62 [3.97, 7.76], p < .001), compared with non‐ascites patients. When classified by ascites severity, determined by imaging, moderate/severe ascites patients had the worst clinical outcomes, with a mortality of 32% and graft failure in 57%, compared with 9% and 10%, respectively, in those without ascites. Conclusion In this large cohort employing stepwise analysis of ascites post‐KT, worse outcomes were noted, dictating the need for optimized management to improve clinical outcomes.