Proportion of glomerulosclerosis in procurement wedge renal biopsy cannot alone discriminate for acceptance of marginal donors

Back-ground. The shortage of available kidneys for renal transplantation co uld be addressed to some extent, by expanding the criteria for acceptance o f marginal donors, The study of these criteria is limited by the selection of grafts actually retrieved and transplanted, therefore reduced to a study of risk factors, We have evaluated the potential of procurement renal biop ies as an instrument for acceptance or refusal of donor kidneys for transpl antation, Methods. This was a prospective study of a consecutive series of 200 donors , Biopsies were performed by wedge technique at the donor operation and wer e evaluated for proportion of glomerulosclerosis, vascular and tubular chan ges, and interstitial fibrosis, The study included 387 renal grafts with a representative biopsy, transplanted, and followed-up for survival and funct ional evaluation; 24 hs creatinine clearance at 1 and 3 weeks, and 3, 6, 12 , 18, and 24 months, Results, Factors associated with initial graft function included cold ische mia time, number of DR mismatches, tubular changes, although donor age show ed the strongest correlation with short- and long-term level of graft funct ion. DR mismatches and retransplantation appeared to be the only significan t risk factors fur graft loss. The proportion of glomerulosclerosis (mean 8 % range 0-48%) correlated with graft function in the simple regression anal ysis, However, when age was taken into account glomerulosclerosis did not c orrelate significantly with graft function, Furthermore, glomerulosclerosis as high as 25% or more had an acceptable 3-year graft survival rate of 74. 7%. Conclusion, Procurement biopsy provides only limited information fur the de cision whether or not to accept a kidney donor.