Background and Aims

Live donor kidney transplantation remains the mainstay of renal replacement therapy in Sri Lanka. The basic universal pre surgical investigations, human leucocyte antigen (HLA) matching and cross matching are routinely performed, however due to high rates chronic kidney disease (CKD) as well as increasing numbers of, chronic kidney disease unknown etiology (CKDu) in Sri Lanka, there is a possibility of subclinical kidney disease being present in donor kidneys which go undiagnosed. A study of pre-implantation biopsy along with follow-up outcomes of kidney transplant recipients is conducted to identify presence of subclinical kidney disease in a Sri Lankan cohort of patients.


We collected thirty three (33) live donor pre-implantation biopsies during 4 consecutive months in 2020 as well as 1 month follow-up data. This is part of an ongoing follow-up study which is conducted at National Hospital, Kandy, Sri Lanka.


Thirty three (33) live donor recipients and their pre-implantation renal biopsy samples were studied. The mean age of the study participants’ was 37.6 (SD 12.5, range 13 – 59) years. A predominant number of male patients were in the sample (n=21, 63.6%). Underlying aetiology of end stage renal disease (ESRD), was predominantly due to chronic hypertension (39.3%; n=13) and diabetic kidney disease (21.2%, n=7) accounting for nearly 60% of the study participants. Among the 33 live donors 1st degree, 2nd degree and non-relative donors were 54.4% (n=18), 18.2% (n=6) and 27.3% (n=9) respectively. Pre-implantation renal biopsy results reported 36.4% (n=12) with abnormal biopsy findings including chronic interstitial nephritis (n=4, 12.1%), interstitial fibrosis (n=6, 18.18%) and acute tubular necrosis (n=2, 6%). Follow-up revealed delayed graft function occurring in 18.2% (n=6) of recipients with 50% (n=3) of them showing abnormalities in the pre-operative donor biopsy sample. At one month follow-up, 48.5% (n=16) reported complications which included graft failure 3% (n=1), all-cause mortality 3% (n=1), acute rejection 39.4% (n=13) and infections 24.2% (n=8). Overall, 37.5% (n=6) of these recipients had abnormal donor biopsy findings, however no significant statistical association was identified.


Our study identified subclinical kidney disease in donor kidneys despite standard pre-transplant screening. Even though, statistically not significant, recipients with abnormal pre-implantation biopsy findings had adverse short term post-transplant complications.