Can zero-hour cortical biopsy predict early graft outcomes after living donor renal transplantation?

Abstract

Introduction: The aim of this study was to identify relevance of subclinical pathological findings in the kidneys of living donors and correlate these with early graft renal function. Methods: This was a prospective study on 84 living donor kidney transplant recipients over a period of two years. In all the donors, cortical wedge biopsy was taken and sent for assessment of glomerular, mesangial, and tubule status. The graft function of patients with normal histology was compared with those of abnormal histological findings at one, three, and six months, and one year post-surgery. Results: Most abnormal histological findings were of mild degree. Glomerulosclerosis (GS, 25%), interstitial fibrosis (13%), acute tubular necrosis (ATN 5%), and focal tubal atrophy (5%) were the commonly observed pathological findings in zero-hour biopsies. Only those donors who had histological changes of interstitial fibrosis and ATN showed progressive deterioration of renal function at one month, three months, six months, and one year posttransplantation. In donors with other histological changes, no significant effect on graft function was observed. Conclusion: Zero-hour cortical biopsy gave us an idea of the general status of the donor kidney and presence or absence of subclinical pathological lesions. A mild degree of subclinical and pathological findings on zero-hour biopsy did not affect early graft renal function in living donor kidney transplantation. Zero-hour cortical biopsy could also help in discriminating donor-derived lesions from de novo alterations in the kidney that could happen subsequently.

Fate of full‐house immunofluorescence staining in renal allograft: A case report

“…In a zero‐hour biopsy, a cortical wedge is taken immediately after revascularization on completion of vascular anastomosis. Zero‐hour renal allograft biopsy could be useful to evaluate subclinical renal lesions present in donors and pathological changes that are being transmitted from the donor to recipient via a grafted kidney . A previous report showed that these lesions are associated with renal prognosis and clinical findings .…”

Kidney Biopsy and Type IV Collagen Gene Sequencing Fail to Explain Hematuria in Loin Pain Hematuria Syndrome

“…21 In a study of 84 donors in India, 48% had abnormal histological changes, which included glomerulosclerosis (25%), interstitial fibrosis (13%), acute tubular necrosis (5%), and focal tubular atrophy (5%). 22 The observed changes are not likely “hidden clues” to as yet unidentified mechanisms for LPHS but rather changes that can be observed in “normal kidneys.”…”

Utility of Banff Human Organ Transplant Gene Panel in Human Kidney Transplant Biopsies

“…Such a unique pattern of gene expression may assist understanding how the status of donor biopsies may affect long-and short-term graft outcomes. [68][69][70][71][72] B cells and Ig/plasma cell transcripts are differentially expressed in TCMR, MIXED, and CAMR suggesting that a plasmacytic pathway is weak or absent in TCMR even though both T and B cells are present. A small subsets of NK transcripts is higher in CAMR/MIXED than TCMR (Figure 3A).…”