#3402 Glomerular morphometry as a predictor of renal graft function

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Abstract Background and Aims Kidney transplantation is currently the best renal replacement therapy; however, the scarcity of available organs requires the use of suboptimal donors. Pre-implantation renal biopsy (PIRB) is a valuable tool in the allocation process, employing non-consensual histopathological scoring systems for prognostic assessment of the renal graft. While glomerulosclerosis negatively correlates with recipient renal function, the relationship between glomerular volumetry and post-transplant outcomes remains uncertain. Objective To evaluate the predictive capacity of simple and calculated glomerular morphometric variables concerning graft function at one-year post-transplant. Methods We conducted a retrospective study including PIRBs digitized via whole slide imaging and assessed by two experienced observers for histopathological parameters, emphasizing glomerular morphometry (major axis, area, and volume, the latter calculated using the Weibel-Gomez formula). Only representative PIRBs were considered, selecting the five largest glomeruli by visual estimation. Additionally, clinical data from donors (including calculation of the Kidney Donor Profile Index—KDPI) and recipients were collected, including estimated glomerular filtration rate at 12 months (eGFR12). Results A total of 133 renal biopsies from 102 deceased donors were analyzed, most of whom were male (n = 65, 63.7%), classified as expanded criteria donors (n = 84, 82.4%), and with KDPI > 85 (n = 55, 53.9%). The leading cause of death was a cerebrovascular accident (n = 69, 67.7%). The mean cold ischemia time was 18.4 hours. Recipients had a mean age of 57.8 years, with 88 patients (66.2%) being male. Five recipients (3.8%) had undergone a previous renal transplant. Among donor characteristics, male donors exhibited a larger mean glomerular diameter; however, the difference was not statistically significant (P = 0.067). Nevertheless, taller donors (P = 0.037), those with diabetes mellitus (P = 0.001), and those with a higher body mass index (P = 0.023) had larger glomeruli, with their recipients achieving a significantly higher eGFR at one-year post-transplant (P = 0.001; P = 0.012; P = 0.039, respectively). Conclusion Based on current knowledge, the association of glomerulomegaly with improved graft function at one-year post-transplant remains controversial, raising questions about the predictive accuracy of mean visual estimation in pre-implantation histopathological assessment. Automated PIRB analysis methods, supported by artificial intelligence, may hold promise for optimizing renal morphometry as a decisive factor in the allocation process.

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