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Published on: May 14, 2013
Adverse effect of donor arteriolosclerosis on graft outcome after renal transplantation
E Pokorná1, S Vítko, M Chadimová
1Transplant Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic. pokorna@medicon.cz
Insights
Donor kidney vascular lesions impact graft function and survival. Kidneys with significant arteriolosclerosis showed lower function and survival rates, highlighting the importance of histological assessment.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pathology
Background:
- Less strict criteria for renal graft donors are increasingly applied.
- Donor kidney histology, particularly vascular changes, may influence transplant outcomes.
- The impact of donor kidney vascular lesions on graft function and survival requires further investigation.
Purpose of the Study:
- To investigate the effect of donor kidney histological findings, specifically vascular changes, on renal graft function and 48-month survival.
- To correlate the severity of arteriolosclerosis in donor kidneys with post-transplant graft outcomes.
Main Methods:
- 150 cadaveric donor kidneys were categorized into three groups based on histological findings: normal (C), mild arteriolosclerosis (M1), and significant arteriolosclerosis (M2).
- Graft function was assessed by need for dialysis, serum creatinine, and creatinine clearance at multiple time points post-transplant.
- Graft survival was evaluated over 48 months.
Main Results:
- Groups M1 and M2 exhibited higher proportions of sclerotic glomeruli and interstitial fibrosis compared to controls.
- Vascular fibrinoid necrosis was more frequent in group M2.
- Group M2 demonstrated significantly lower graft function and a reduced 4-year graft survival rate (74.2%) compared to the combined C+M1 group (P=0.03).
Conclusions:
- Significant vascular lesions in donor kidneys negatively impact graft function and long-term survival.
- Histological assessment of donor kidneys, focusing on vascular changes, is crucial for predicting transplant outcomes.
- Consideration of donor kidney pathology can refine donor selection and improve patient management in renal transplantation.
Introduction:
In recent years less strict criteria for renal graft donors have been applied. Our study was designed to investigate whether the histological picture, with special reference to vascular changes of the donor kidney, has an effect on the development and level of graft function, and on 48-month graft survival.
Methods:
Three morphologically distinct groups were formed from 150 consecutive cadaveric kidneys donors transplanted into 290 recipients. A control group (C) consisted of kidneys with a completely normal histological picture. Group M1 included kidneys with mild arteriolosclerosis and group M2 (n=122) was comprised of kidneys showing significant arteriolosclerosis. The onset of graft function was assessed by the need for dialysis treatment post-transplantation and the levels of serum creatinine and creatinine clearance at 6, 12, 24 and 36 months post transplant.
Results:
The proportion of sclerotic glomeruli (P<0.001) and the incidence and severity of interstitial fibrosis was greater in groups M1 and M2 than in the control group (M1, P<0.01; M2, P<0.001). The incidence of vascular fibrinoid necrosis in M2 was greater than in controls (P<0.001). The onset of graft function did not differ significantly between the groups. Group M2 showed a significantly lower level of graft function (P<0.001). The 4-year graft survival rate of group M2 was 74.2%, significantly lower than in the combined group C+M1 (P=0.03).
Conclusion:
Significant vascular lesions in the donor kidney should be taken into account when predicting graft function and survival.
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