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.
Keywords: Expanded Criteria Donor, Dual Kidney Transplantation, Biopsy, Histological Evaluation,
Glomerulosclerosis, Tubular Necrosis, Interstitial Fibrosis, Vascular, Marginal Donor, Dual Kidney
Transplantation.
