Journal of nephrology · 2025
Kidney transplant from donation after circulatory death: a novel pre-transplant combined clinico-pathological predictive score.
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Bizzo Leonardo, Mansour Nadia, Storaci Alessandra Maria, Rossi Maria Carmela, De Feo Tullia, Ferrero Stefano, Del Gobbo Alessandro, Gianelli Umberto
Аннотация
BACKGROUND: Kidney donation after circulatory death is a valid alternative to donation after brain death. However, ischemia-reperfusion injury can damage the graft and make it non-viable. The Karpinski score, currently used to evaluate kidney quality, does not account for this type of damage and is, therefore, insufficient for predicting expected functional recovery.
METHODS: Sixty-seven kidney biopsies from donors after circulatory death and seventy-two kidney biopsies from donors after brain death were analyzed histologically. A Karpinski score was assigned to all samples. Additionally, biopsies obtained from donation after circulatory death were reviewed for the presence of ischemia-reperfusion injury defined as brush border loss within the tubular epithelium as well as acute tubular injury. Clinical data were also retrieved and analysed, in an attempt to find a statistically significant correlation between histological/clinical findings and graft function.
RESULTS: The mean Karpinski scores of samples obtained on the occasion of donation after circulatory death and after brain death showed no significant difference. Ischemia-reperfusion injuries were two times more frequent in samples obtained after donation after circulatory death compared to donation after brain death. Statistical analysis revealed that a cutoff of 15% in brush border loss and 0.9 mg/dL in serum creatinine before death allowed to predict functional recovery, especially delayed functional recovery. A composite predictive score summing these two parameters was therefore created.
CONCLUSIONS: Donation after circulatory death is associated with unique patological characteristics compared to donation after brain death and requires different considerations. This study proposes a simple and clinically applicable tool for predicting the delayed functional recovery in the case of kidneys donated after circulatory death; the novelty lies in combining morphological (brush border loss) and biochemical (serum creatinine before death) into a new predictive score that may provide support for pre-implantation decision-making and potentially improve transplant outcomes.
METHODS: Sixty-seven kidney biopsies from donors after circulatory death and seventy-two kidney biopsies from donors after brain death were analyzed histologically. A Karpinski score was assigned to all samples. Additionally, biopsies obtained from donation after circulatory death were reviewed for the presence of ischemia-reperfusion injury defined as brush border loss within the tubular epithelium as well as acute tubular injury. Clinical data were also retrieved and analysed, in an attempt to find a statistically significant correlation between histological/clinical findings and graft function.
RESULTS: The mean Karpinski scores of samples obtained on the occasion of donation after circulatory death and after brain death showed no significant difference. Ischemia-reperfusion injuries were two times more frequent in samples obtained after donation after circulatory death compared to donation after brain death. Statistical analysis revealed that a cutoff of 15% in brush border loss and 0.9 mg/dL in serum creatinine before death allowed to predict functional recovery, especially delayed functional recovery. A composite predictive score summing these two parameters was therefore created.
CONCLUSIONS: Donation after circulatory death is associated with unique patological characteristics compared to donation after brain death and requires different considerations. This study proposes a simple and clinically applicable tool for predicting the delayed functional recovery in the case of kidneys donated after circulatory death; the novelty lies in combining morphological (brush border loss) and biochemical (serum creatinine before death) into a new predictive score that may provide support for pre-implantation decision-making and potentially improve transplant outcomes.