LABORATORY IMMUNOLOGY AND KIDNEY TRANSPLANTATION

R. Munivenkatappa¹, G. Malat², S. Soundararajan², K. Ranganna², C. Drachenberg¹, J.C. Papadimtriou¹, S.A. Fayek³, R.N. Barth⁴, M. Cooper⁴, K. David¹, E.J. Schweitzer¹, S.T. Bartlett⁵, M. Kumar⁶, B. Philosophe^5
1, University of Maryland School of Medicine, Baltimore/MD/UNITED STATES OF AMERICA, ²Pathology, Drexel University College of Medicine, Philadelphia/UNITED STATES OF AMERICA, ³Surgery- Division Of Transplantation, University of Maryland Medical Center, Baltimore/MD/UNITED STATES OF AMERICA, ⁴Surgery, University of Maryland, Baltimore/UNITED STATES OF AMERICA, ⁵Surgery, university of maryland, baltimore/UNITED STATES OF AMERICA, ⁶Pathology, Drexel University College of Medicine, Philadelphia/PA/UNITED STATES OF AMERICA

Body: Predicting delayed graft function (DGF) after renal transplantation based on donor histological features has remained elusive and is subject to institutional variability. We have shown in a retrospective study that a MAPI score reliably predicts long term graft outcome. We sought to examine the association of MAPI histolopathological parameters with DGF prospectively in our center (center 1) and in a second independent transplant center (center 2).
We analyzed 140 deceased donor kidney transplants from center 1 between January 2007 and June 2009 and 65 DD from center 2 between May 2008 and October 2009. The patients had a mean follow up of 509±292 and 279±157 days respectively. T-test, Chi-square test, ANOVA and Logistic regression. Kaplan-Meier survival curves were used with Log-Rank comparisons. There were no significant differences in donor or recipients characteristics except for recipient race (p=0.05) . A logistic regression (multivariate analysis) model splitting the cohort into 2/3 model group and 1/3 validating group revealed that donor kidney interlobular arteries with a wall to lumen ratio (WLR) >0.5, or equivalent to Bannf cv2 lesion, had an odds ratio of 8.68 (95%CI1.69-44.61) (p=0.01) in developing DGF. Terminal creatinine >1.5 had an odds ratio of 2.55 (95% CI 1.02-6.37) (p=0.05) [Table1]. However there was no difference in 2.5 year graft survival between DGF and no DGF patients (81% vs. 74.3%, p=0.2). Conclusion: Although the presence of DGF has been linked to donor history, creatinine and cold ischemia time, an underlying Banff cv2 lesion is the best independent parameter to predict the development of DGF after kidney transplantation. Table. 1

Disclosure: All authors have declared no conflicts of interest.