Pre-transplant histological evaluation in kidney transplantation

The increased discrepancy between the number of patients on the waiting list and the kidney graft availability has prompted most of the transplant centers to expand their suitability criteria for deceased donor kidneys. However, these grafts have a potential lower graft functionality and must be properly allocated to ensure the best outcome. Histopathological pre-transplant evaluation has progressively assumed as the best prognostic factor for graft function in kidney transplantation from older donors. However, there is not consensus about the best strategy of scoring the bioptic samples and there are no clinical trials comparing the best allocation strategy of these kidneys. In this chapter will be reviewed the recent acquisition on pre-transplant histopathologic examination with a brief overview on the role of kidney biopsy in living kidney donors.