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The Association Between Macroscopic Arteriosclerosis of the Renal Artery, Microscopic Arteriosclerosis, Organ
Anke Keijbeck1, Rob Veenstra2, Robert A Pol2
1Department of Pathology, Maastricht University Medical Center, University of Maastricht, Maastricht, The Netherlands.
Insights
Macroscopic arteriosclerosis in donor kidneys is linked to increased discard rates and primary nonfunction. However, it does not significantly impact long-term transplant outcomes like graft survival or function.
Area of Science:
- Nephrology
- Transplantation Surgery
- Cardiovascular Pathology
Background:
- Surgeons assess renal artery arteriosclerosis during organ retrieval to guide organ acceptance decisions.
- The impact of macroscopic renal artery arteriosclerosis on donor kidney discard and transplant success requires further elucidation.
Purpose of the Study:
- To investigate the association between macroscopic renal artery arteriosclerosis and donor kidney discard.
- To examine the relationship between renal artery arteriosclerosis and kidney transplant outcomes, including graft survival and function.
- To explore the correlation between macroscopic and microscopic (histological) assessments of arteriosclerosis.
Main Methods:
- A retrospective analysis of 2610 donor kidneys transplanted or discarded in the Netherlands (2000-2015) from donors aged 50+ was conducted.
- Data on macroscopic renal artery arteriosclerosis were collected and analyzed for associations with kidney discard and transplant outcomes.
- Statistical methods included logistic regression for discard and primary nonfunction, and survival analysis for graft survival.
Main Results:
- Macroscopic renal artery arteriosclerosis was independently associated with kidney discard (OR, 1.36; P=0.03).
- Mild arteriosclerosis showed a significant association with primary nonfunction (OR, 2.14; P=0.01).
- No significant associations were found between any degree of arteriosclerosis and delayed graft function, 1-year estimated glomerular filtration rate, or long-term graft survival. No correlation was observed between macroscopic and histological arteriosclerosis or their impact on outcomes.
Conclusions:
- Macroscopic renal artery arteriosclerosis is a significant factor in donor kidney discard decisions.
- While associated with discard and primary nonfunction, arteriosclerosis does not appear to negatively affect key long-term transplant outcomes.
- Potential bias exists due to the exclusion of discarded kidneys with higher arteriosclerosis burden, necessitating cautious interpretation of findings.
Background:
During organ retrieval, surgeons estimate the degree of arteriosclerosis and this plays an important role in decisions on organ acceptance. Our study aimed to elucidate the association between macroscopic renal artery arteriosclerosis, donor kidney discard, and transplant outcome.
Methods:
We selected all transplanted and discarded kidneys in the Netherlands between January 1, 2000, and December 31, 2015, from deceased donors aged 50 y and older, for which data on renal artery arteriosclerosis were available (n = 2610). The association between arteriosclerosis and kidney discard, the relation between arteriosclerosis and outcome, and the correlation between macroscopic and microscopic arteriosclerosis were explored.
Results:
Macroscopic arteriosclerosis was independently associated with kidney discard (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.02-1.80; P = 0.03). Arteriosclerosis (any degree) was not significantly associated with delayed graft function (OR, 1.16; 95% CI, 0.94-1.43; P = 0.16), estimated glomerular filtration rate 1-y posttransplant (B, 0.58; 95% CI, -2.07 to 3.22; P = 0.67), and long-term graft survival (hazard ratio, 1.07; 95% CI, 0.86-1.33; P = 0.55). There was a significant association between mild arteriosclerosis and primary nonfunction (OR, 2.14; 95% CI, 1.19-3.84; P = 0.01). We found no correlation between macroscopic and histological arteriosclerosis, nor between histological arteriosclerosis and transplant outcome.
Conclusions:
Macroscopic arteriosclerosis of the renal artery was independently associated with kidney discard and somewhat associated with primary nonfunction posttransplant. However, there was no effect of arteriosclerosis on delayed graft function, estimated glomerular filtration rate at 1 y, or long-term graft survival. Our results are valid only after inevitable exclusion of discarded kidneys that had on average more arteriosclerosis. Hence, conclusions should be interpreted in the light of this potential bias.
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