Introduction: The kidney donor profile index (KDPI) and histopathological findings in implantation renal allograft biopsies could provide information on prediction of graft survival. 
Our aim is to evaluate the association between KDPI and histopathological changes in implantation renal allograft biopsies among patients who underwent kidney transplantation (KT) from a deceased donor. 
Methods: This is a retrospective cohort study. Adult patients who underwent KT from a deceased donor between 01/01/2013 and 29/12/2018 in Ege University, School of Medicine were retrospectively analyzed and clinical findings were recorded. A tru-cut biopsy of the transplanted kidney was taken immediately after revascularization on completion of vascular anastomosis from all recipients. The paraffin embedded biopsy specimens were retrospectively evaluated and histopathological findings were scored semi-quantitatively. 
Results: A total of 219 consecutive adult patients underwent KT between 01/01/2013 and 29/12/2018. After exclusion of patients with primary non-function graft (n=16), patients transplanted from a donor aged <18 years (n=3), patients who underwent en-bloc transplantation (n=4), patients with inadequate biopsy samples (n=15) and patients who died within first week of KT (n=8), a total of 173 patients were included. 
The mean age of recipients was 47±9.7.1 years and 48.6% was female. The mean age of donors was 44.9±13.5 years. Glomerulosclerosis (GS) was present in 54.9%, arteriolar hyalinosis (ah) in 21.4% and interstitial fibrosis-tubular atrophy (IFTA) in 15.6% of implantation biopsies. KDPI was positively correlated with presence of GS (p<0.001), IFTA (p=0.001) and ah (p=0.004) in implantation biopsies. 
Mean serum creatinine level was1.36±0.89 mg/dl at the first year of follow-up. Serum creatinine level at first year was significantly correlated with presence of GS (p<0.001), IFTA (p=0.002) and ah (p=0.004). KDPI was also correlated with serum creatinine level at first year (p<0.001). In linear regression analysis including donor age, gender, KDPI, cold ischemia time (CIT), duration of delayed graft function (DGF), HLA mismatches and presence of GS, IFTA and ah, only KDPI was associated with serum creatinine at first year (Beta:0.467, t:4.513, p<0.001)
Overall graft survival was 93.6% and 81.4% respectively at first and fifth year. In multivariate regression analysis including donor age, gender, KDPI, CIT, duration of DGF, HLA mismatches and presence of GS, IFTA and ah, overall graft survival was associated with donor age (Exp(B)=1.049, 95%CI 1.016-1.084, p=0.004) and duration of DGF (Exp(B)=1.045, 95% CI 1.001-1.090, p=0.043).
Conclusion: KDPI is independently associated with serum creatinine at first year. Overall graft survival associated with donor age and duration of DGF.