Outcome of kidney transplantation from high-risk donors is determined by both structure and function

Method. Despite the need to expand the donor pool, it is unclear what; para meters should be used, The value of donor renal pathology and calculated cr eatinine clearance (CrCl) in determining recipient outcome was assessed in 57 kidney transplants from 34 donors in whom pretransplant renal biopsies w ere performed because of age greater than or equal to 60, hypertension, and /or vascular disease. me retrospectively compared clinical outcomes in thes e recipients and 57 control recipients selected to have the same baseline d emographics but receiving transplants from low risk donors who were signifi cantly younger (32+/-13.9 vs. 61+/-7.3 years) and lighter weight (71+/-18.1 vs. 84+/-20.2 kg) than the high-risk donors (P<.001 for both). Results. Recipients of high-risk kidneys had a higher incidence of delayed graft function, defined by a <10% fall in serum creatinine (Cr) in the firs t 24 hr, (56% vs, 30%, P<.01), a higher incidence of rejection (60% vs. 37% , P=.02) and a higher Cr level (197+/-64 vs. 144+/-54 mu mol/L at 18 months , P<.005). Graft and patient survival were similar; 12% and 5% vs, 9% and 9 % in highrisk vs. control groups, respectively (P=NS). Donor renal patholog y was scored 0-3 (none to severe disease) in four areas: glomerulosclerosis , interstitial fibrosis, tubular atrophy, and vascular disease. A donor ves sel score of 3/3 was associated with a 100% incidence of delayed graft func tion and a mean 1-year Cr level of 275+/-106 mu mol/L (compared with 43% an d 192+/-54 mu mol/L in those with lower vessel scores, P<.05). Calculated d onor CrCl <100 ml/min was associated with higher recipient Cr levels at 1 y ear, 240+/-95 mu mol/L vs. 180+/-54 mu mol/L in recipients of kidneys from donors with CrCl levels >100 ml/min (P<.05). The mean 1-year Cr level was 3 20+/-102 mu mol/L in recipients with both a vascular score of 3/3 and a don or CrCl<100 ml/min and 184+/-63 mu mol/L in those with neither factor (P=.0 01). Conclusion. Calculated donor CrCl and donor vascular pathology predict reci pient graft function and may be helpful in selecting high-risk donors for s ingle kidney transplantation.