The presence of glomerular sclerosis at time zero has a significant impact on function after cadaveric renal transplantation

Introduction. The aim was to determine the impact of donor glomerulosclerosis on allograft outcome. Methods. The percentage of glomerular sclerosis (%GS) was calculated in protocol biopsies taken at engraftment. Clinical variables were obtained from the Welsh Transplantation Research Group (WTRG) database. Results. Of 210 allografts, 129 showed %GS=0, but 81 kidneys showed %GS between 1 and 60. Patients with %GS=0 had the highest glomerular filtration rate (GFR) at 1 year (62.0 mL/min) and the slowest deterioration of function (-3.8 mL/min per year). Patients with %GS greater than 20 had the lowest GFR at 1 year (36.0 ml/min) and the steepest rate of deterioration (-9.0 mL/min per year). The %GS of 10 alone can reduce GFR at 4 years by 8 ml/min, a similar reduction to a single rejection episode or an increase in donor age of 30 years. Actuarial 5-year graft survival for %GS=0 was 80%, and for %GS greater than 20 was 35% (P=0.04). Conclusion. The findings indicate that a biopsy taken at procurement will provide information for the most appropriate allocation of a kidney.