Pathological analysis of time-zero renal biopsy in donor kidney

Objective To summarize the pathological survey of time-zero renal biopsy (T0-RBx). Methods The material qualities and pathological features were analyzed retrospectively for T0-RBx (n=176) between March 2008 and May 2016. According to the source of donor kidney, T0-RBx specimens were divided into living donors (LD) group (n=137) and Deceased donation (DD) group (n=39). Furthermore, the DD group was divided into cerebral hemorrhage group (n=10) and brain trauma group (n=29) according to the causes of death. The inter-group differences of pathological characteristics and the effects of abnormal pathological lesions on allograft function were observed. Results All T0-RBx specimens contained cortical kidney tissue. The average microscopic length of renal tissue was (0.39±0.23) cm and the median glomerular number 11. The abnormal pathological lesions included glomerulosclerosis (GS, 30.7 %), segmental glomerulosclerosis (1.1 %), mesangial increase (MI, 19.3 %), tubular atrophy (TA, 35.2 %), acute tubular necrosis (ATN, 9.1 %), vacuolar degeneration of tubular epithelium (27.3 %), losses in tubule epithelial brush border (97.7 %), protein cast (25 %), interstitial fibrosis (IF, 34.1 %), inflammation (I, 42.6 %), arteriolar hyalinosis (AH) (26.1 %) and vascular fibrous intimal thickening (CV, 23.3 %). Among them, 23.9 %, 1.1 %, 0.55 % and 0.55 % cases were diagnosed as IgA nephropathy, immune complex associated with glomerular disease and focal segmental glomerulosclerosis diabetic nephropathy respectively. And the reminders were of ischemic injury. The incidence rates of TA, IF and I were lower in DD group than those in LD group (P 0.05). Further analysis showed GS was related with allograft function at 6/12 months post-transplantation in both LD and DD groups (P 0.05). Conclusions T0-RBx may detect the abnormal lesions of donor kidney. Some differences exist in types and degree of abnormal lesions among different donor kidneys. LD group has a higher risk for chronic histological injury such as TA and IF while DD group is more susceptible to acute renal tubular interstitial injury. Thus it is valuable for predicting allograft function post-transplantation. Material quality is essential for ensuring the reliability of T0-RBx. Key words: Renal transplantation; Living related donor; Fine-needle aspiration biopsy; Docoased donation