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Risk factors for late renal allograft dysfunction: effects of baseline glomerular size
Mingxi Li1, Kathy M Nicholls, Gavin J Becker
1Department of Nephrology, Peking Union Medical College Hospital, Beijing, China.
Insights
Glomerular size in baseline kidney biopsies predicts long-term allograft function. Larger glomerular size, indicating hypertrophy, is a risk factor for chronic renal allograft dysfunction.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pathology
Background:
- Alloantigen-dependent and independent factors influence late allograft dysfunction.
- Donor kidney mass is an understudied factor in allograft outcomes.
- Glomerular hypertrophy is hypothesized to be a risk factor for graft function decline.
Purpose of the Study:
- To investigate the role of glomerular size in predicting late allograft dysfunction.
- To determine if glomerular hypertrophy is a risk factor for chronic renal allograft dysfunction.
Main Methods:
- Morphometric analysis of baseline graft biopsies (1990-1998) using maximal profile area (MPA) for glomerular size.
- Correlation analysis between glomerular size and creatinine clearance (Ccr) at multiple time points post-transplant.
- Multivariate analysis to identify covariates associated with Ccr, including glomerular size, global glomerulosclerosis (GS%), baseline Ccr, cold ischemic time (CIT), and rejection episodes.
Main Results:
- Eighty-six patients were analyzed.
- Maximal profile area (MPA) was significantly correlated with Ccr at 6 months, 1, 3, and 4 years post-transplant.
- Other significant covariates included GS%, baseline Ccr, CIT, and rejection episodes.
Conclusions:
- Glomerular size in baseline biopsies is a significant predictor of late allograft function.
- Hypertrophied glomeruli, along with other factors, contribute to chronic renal allograft dysfunction.
Background:
Both alloantigen dependent and alloantigen independent factors contribute to late allograft dysfunction. Among the latter, the importance of the mass of the donor kidney is an issue of interest. We hypothesized that glomerular hypertrophy is a risk factor for deterioration of allograft function. The goal of this study was to examine the role of glomerular size in predicting late allograft dysfunction.
Methods:
All baseline graft biopsies between 1990 and 1998 were reviewed and sections containing at least 15 glomeruli were selected for morphometric analyses. Glomerular size was measured using the maximal profile area (MPA) method. Linear correlations between creatinine clearance (Ccr) and variables were evaluated. Covariates that tended to correlate with Ccr on univariate analysis (p < 0.2) were examined using multivariate analysis to determine the covariates associated with Ccr at 6 months (M) and 1, 2, 3, 4 years (yrs) after transplantation.
Results:
Eighty-six patients were enrolled. Donor age, MPA, baseline Ccr, percent of global glomerulosclerosis (GS%), cyclosporin nephrotoxicity, cold ischemic time(CIT) and episodes of rejection were significantly correlated with interval Ccr in univariate analyses. MPA was a significant covariate at 6M, 1 yr, 3 yrs and 4 yrs. Other covariates significantly associated with interval Ccr included GS%, baseline Ccr, CIT and number of acute rejection episodes.
Conclusions:
Glomerular size in baseline biopsies is predictive of late allograft function, and the presence of hypertrophied glomeruli combined with other factors contributes to chronic renal allograft dysfunction.