biostudies-literatureUnknown47(1)Wang MNational Natural Science Foundation of China<h4>Objectives</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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%, <i>p</i> = 0.984), whereas grafts with score >4 had poorer outcomes (82.0%, <i>p</i> = 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%, <i>p</i> = 0.122), while score >4 trended toward worse survival (81.0%, <i>p</i> = 0.067). In subgroup analyses of high Remuzzi scores (>4, <i>n</i> = 105), the Kidney Donor Profile Index (KDPI) and donor terminal creatinine were identified as independent risk factors for graft loss.<h4>Conclusions</h4>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.Renal failure2588506https://www.ebi.ac.uk/biostudies/studies/S-EPMC12697274biostudies-literatureDonor kidney pathology combined with clinical parameters helps expand the kidney donor pool: a large-scale retrospective cohort study.PMC12697274Wang MWu JZhou QChen JWang RGao XWang HLuo SfalseDonor kidney pathology combined with clinical parameters helps expand the kidney donor pool: a large-scale retrospective cohort study.<h4>Objectives</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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%, <i>p</i> = 0.984), whereas grafts with score >4 had poorer outcomes (82.0%, <i>p</i> = 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%, <i>p</i> = 0.122), while score >4 trended toward worse survival (81.0%, <i>p</i> = 0.067). In subgroup analyses of high Remuzzi scores (>4, <i>n</i> = 105), the Kidney Donor Profile Index (KDPI) and donor terminal creatinine were identified as independent risk factors for graft loss.<h4>Conclusions</h4>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.2025-01-01T00:00:00Z2025 Dec2026-06-06T01:26:56.163Z2026-05-24T03:11:26.033ZS-EPMC126972744136914110.1080/0886022X.2025.2588506