Baseline Vascular Pathology in Deceased Donor Kidneys: Differential Impact on Transplant Outcomes by Donor Type

Background The impact of kidney vascular pathology on transplant outcomes remains poorly understood, particularly under specific donor conditions. Methods This retrospective single‐center study analyzed 837 deceased donor kidney transplants. Based on baseline vascular histology, the kidneys were categorized into two groups: minimal vascular disease (Group 0, n = 637) and significant vascular disease (Group 1, n = 200). Five‐year graft survival and 6‐ and 12‐month kidney function were evaluated, along with subgroup analyses of various donor characteristics. Propensity score matching was used to adjust for confounding factors. Results Recipients of kidneys with significant vascular disease showed worse 5‐year overall graft survival (64.6% vs. 80.0%, p = 0.0002) and death‐censored graft survival (85.6% vs. 91.5%, p = 0.0126). These differences persisted after propensity score matching. The impact was most pronounced in hypertensive donors (53.4% vs. 84.9%) and diabetic donors (52.3% vs. 69.0%). Circulatory death donors showed immediate adverse effects, while brain death donors demonstrated delayed deterioration. Kidneys with significant vascular disease exhibited lower glomerular filtration rates at follow‐up. Conclusion Baseline vascular disease in deceased donor kidneys has a significant impact on transplant outcomes, independent of clinical risk factors. These findings support the incorporation of vascular histological assessment into donor evaluation to enhance risk stratification and optimize post‐transplant management.