Donor kidney pathology combined with clinical parameters helps expand the kidney donor pool: a large-scale retrospective cohort study.

ABSTRACT:

Objectives

The disparity between kidney demand and supply necessitates the expansion of the donor pool. This study evaluates the long-term outcomes of single kidney transplantation guided by histological and clinical parameters.

Methods

We retrospectively analyzed 1,024 adult recipients of deceased-donor kidney transplants from January 2011 to December 2020. Graft and patient survival were assessed using Kaplan-Meier analysis, and independent risk factors were identified through Cox regression models. Donor kidney histological specimens were evaluated using the Remuzzi score.

Results

A Remuzzi score of 4 emerged as a critical threshold for safe single kidney transplantation. Recipients were divided into three groups based on Remuzzi score (0-3, 4, and >4). Those with a score of 4 had similar 10-year graft survival to those with score 0-3 (92.0% vs. 92.0%, p = 0.984), whereas grafts with score >4 had poorer outcomes (82.0%, p = 0.033). The 10-year patient survival for recipients with a score of 4 was comparable to those with scores 0-3 (90.0% vs. 94.0%, p = 0.122), while score >4 trended toward worse survival (81.0%, p = 0.067). In subgroup analyses of high Remuzzi scores (>4, n = 105), the Kidney Donor Profile Index (KDPI) and donor terminal creatinine were identified as independent risk factors for graft loss.

Conclusions

Single kidney transplantation is safe for grafts with Remuzzi scores ≤4. Even some kidneys from high-score donors demonstrated favorable graft prognosis when allocated based on KDPI and donor terminal creatinine.

SUBMITTER: Wang M 

PROVIDER: S-EPMC12697274 | biostudies-literature | 2025 Dec

REPOSITORIES: biostudies-literature