A histopathological score on baseline biopsies from elderly donors predicts outcome 1 year after renal transplantation

Kidneys from elderly deceased patients and otherwise marginal donors may be considered for transplantation and a pretransplantation histopathological score for prediction of postoperative outcome is warranted. In a retrospective design, 29 baseline renal needle biopsies from elderly deceased donors (age: 63 +/- 4 years; mean +/- SD) were evaluated independently by three pathologists and with ten or more glomeruli and one artery present the biopsy was histopathologically scored (numeric score: 0-12) according to the presence of glomerulosclerosis, tubular atrophy, interstitial fibrosis and increased wall thickness of arteries and / or arterioles. Nineteen renal baseline biopsies from 15 donors (age: 64 +/- 10 years) were included and following consensus the histopathological score was 4.3 +/- 2.1 (intraclass correlation coefficient: 0.81; confidence interval: 0.66-0.92). The donor organs were used for single renal transplantation (recipient age: 47 +/- 3 years). Two grafts were lost after the transplantation. In the remaining 17 recipients the 1-year creatinine clearance (54 +/- 6 mL/ min) correlated to the baseline histopathological score (r(2) = 0.59; p < 0.01). This study demonstrates that in elderly Danish donors a histopathological score on baseline renal needle biopsies, with at least ten glomeruli and one artery present, predicts graft function 1 year after transplantation.