Introduction: The analysis of pretransplant biopsies from cadaveric donor shows frequently chronic abnormalities especially glomerular sclerosis and vascular changes.
Patients and methods: Inclusion criteria (n=300): engraftment between 2000 - 2008, availability of implantation kidney allograft biopsy.  As chronic abnormalities present in donor biopsy we analysed arteriolar hyalinisation (ah), interstitial fibrosis (ci), intimal sclerotisation (cv), tubular atrophy (ct), total inflammation (ti) and percentage of sclerotic glomeruli (Banff Classification).
The multivariate analysis of various factors associated with donor, recipient and kidney transplantation were performed. The analysed factors depending on donor were: sex, age, diabetes mellitus, hypertension, cause of death, serum creatinine, HCV, HBV and CMV infection; depending on recipients: sex, BMI, diabetes mellitus, hypertension, proteinuria after kidney transplant, kidney function 12 months after transplant, acute rejection, HCV, HBV and CMV infection, previous transplant history, and moreover mismatches, PRA, CIT, DGF.
Statistical analysis: Multivariate analysis by Cox proportional hazard.
Results
1. There was no correlation between present of chronic histopathological changes in kidney biopsy and the risk of graft loss in renal transplant recipients.
2. Independent risk factors of graft loss were donor age (HR 1.039 (1.015- 1.065) p=0.0003), HCV infection in recipients (HR 2.395 (1.252 – 4.582) p=0.0065), proteinuria 3 months after kidney transplant (HR 1.718 (1.045 – 2.823) p=0.0118) and diabetes mellitus in recipients (HR 2.003 (1.010 – 3.973) p=0.0430).
Conclusion
1. In this study donor age as a risk factor of graft loss in renal transplant recipients was confirmed. Donor age seems to be associated with natural process of all organs aging.
2. There was no correlation between chronic histopathological abnormalities and graft loss in renal transplant recipients.
3. Banff Classification, without clinical examination seems to have limited value for the assessment of kidney "zero" biopsy.
4. Increasing risk of graft loss in recipients with HCV infection suggest treatment of HCV infection before kidney transplant.