Significant glomerulosclerosis in extended criteria donor (ECD) procurement biopsy samples is associated with graft failure, investigators report.

The finding is from an analysis of 3851 ECD kidney donors in the BARETO (Biopsy, Anatomy, and Resistance Effects on Transplant Outcomes) study who had at least 1 kidney biopsied and transplanted.

Having more than 10% glomerulosclerosis (vs only 0%–5%) in the ECD kidney biopsy samples increased the risk for all-cause graft failure by 18% and death-censored graft failure by 28% over 10 years, Darren E. Stewart, MS, of United Network for Organ Sharing in Richmond, Virginia, and colleagues reported in Kidney International Reports.

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According to the investigators, an 18% increased risk for graft failure is similar to the risk associated with diabetes in the donor, a 0.7 higher creatinine level, or 7 additional years in donor age.

“Despite being obtained under less than ideal conditions, estimated [glomerulosclerosis] from a procurement biopsy is independently associated with long-term graft survival, above and beyond standard clinical parameters, in ECD transplants,” the study authors stated.

Graft failure risk plateaued when glomerulosclerosis increased beyond 10%. Yet the kidney discard rate spiked.

According to the investigators, the disproportionately high likelihood of discard for kidneys with glomerulosclerosis greater than 10% is unjustified. “The outsized effect of [glomerulosclerosis] on kidney utilization should be tempered and commensurate with its effect on outcomes.”


Stewart DE, Foutz J, Kamal L, et al. The independent effects of procurement biopsy findings on 10-year outcomes of extended criteria donor kidney transplants. Kidney Int Rep. Published online May 30, 2022. doi:10.1016/j.ekir.2022.05.027