Can donor implantation renal biopsy predict long-term renal allograft outcome?

Background: Donor kidney implantation biopsy (IB) is performed on a regular basis, particularly as part of clinical studies. Objective: To determine the utility of donor implantation renal biopsy to predict the long-term renal allograft outcome. Methods: A Medline search for studies in English was performed with the following key words: implantation biopsy, renal transplantation and long-term outcome. Results: Sixteen trials involving 8,122 kidney transplants were identified, of which 6 were prospective studies. The histological abnormalities were scored mainly by the Banff schema and the graft outcome was defined either by delineating the delta changes in the pathology score or glomerular filtration rate. Normal histology with a well-functioning renal allograft had a favorable outcome. The extent to which the baseline tubular atrophy, interstitial fibrosis, glomerulosclerosis and vascular changes had on the long-term outcome varied from one study to another. Conclusion: Abnormal IB has a better chance of predicting early graft outcome. The review questions the current wisdom for routine IB on all donors. In some donor kidneys, a biopsy provides significant prognostic information, such as older donor kidney, those with history of hypertension, diabetes, cardiovascular disease, and kidneys with abnormal creatinine. Future research on IB is necessary to find a more useful method to predict the long-term transplant outcome. Copyright (c) 2007 S. Karger AG, Basel