Arteriolar hyalinization predicts delayed graft function in deceased donor renal transplantation.

Delayed renal graft function (DGF) remains a largely unpredictable and burdensome consequence of deceased donor renal transplantation. There is growing evidence that histologic and molecular analyses of baseline donor kidney biopsies can predict both short- and long-term graft outcome. We performed histologic analyses of 172 preimplantation kidney biopsies to determine reliable histologic risk factors for DGF. Fifty-six recipients presented a DGF (incidence 32%). Univariate analysis revealed that arteriolar hyalinization (P=0.019), arterial intima fibrosis (0.004), donor age (P=0.001), duration of cold ischemia time (P=0.001), and recipient age (P=0.001) were significantly associated with DGF. Multivariate analysis revealed that the only independent histologic factor was arteriolar hyalinization (P=0.036). This histologic predictive factor, together with previously identified clinical risk factors, could guide clinical decisions regarding use, allocation, or immunosuppression protocols for minimization of DGF.