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[Nephro-angiosclerosis in the graft: impact on graft survival. Study of 33 cases]
P Bernadet-Monrozies1, L Rostaing, A Modesto
1Service de néphrologie, unité transplantation d'organes, CHU Rangueil, Toulouse.
Insights
Early kidney transplant biopsies showing hypertensive nephrosclerosis, often linked to older donors, predict recipient hypertension without immediate graft dysfunction. Acute rejection episodes worsen graft function in these cases.
Area of Science:
- Nephrology
- Transplantation Medicine
- Pathology
Background:
- Early kidney transplant biopsies can reveal hypertensive nephrosclerosis, characterized by hyaline arteriosclerosis and intimal thickening.
- These findings are often presumed to originate from the donor kidney.
Purpose of the Study:
- To determine if early renal biopsy findings of nephrosclerosis predict clinical outcomes in kidney transplant recipients.
- To analyze short- and mid-term renal function and blood pressure in relation to early biopsy results.
Main Methods:
- Analysis of 97 early graft biopsies (within one month post-transplant) from 439 cadaveric renal transplantations.
- Comparison of patients with (Group I) and without (Group II) nephrosclerosis lesions regarding donor age, recipient factors, graft function, and hypertension.
- Assessment of renal function via creatinine clearance and blood pressure monitoring over a mean follow-up of approximately 4.5 years.
Main Results:
- Nephrosclerosis lesions were found in 33 patients (Group I), absent in 64 (Group II).
- Group I had significantly older donors (39.1 years) compared to Group II (26.9 years).
- Group I showed a higher incidence of requiring hemodialysis (30% vs. 9.8%) and a significantly higher prevalence of hypertension at 2 years and last follow-up.
Conclusions:
- Donor age is a critical factor in early graft nephrosclerosis observed in biopsies.
- Donor-related nephrosclerosis is an independent risk factor for developing post-transplant hypertension, without compromising mid-term graft function.
- In cases of early nephrosclerosis, acute rejection episodes negatively impact graft function.
Unlabelled:
When early kidney transplant biopsies showed benign hypertensive nephrosclerosis, i.e. hyalin arteriosclerosis and/or interlobular arteries intimal thickening, they are thought to be of donor origin. Between 1987 and 1992, 439 cadaveric renal transplantations have been performed in our department: amongst them 97, i.e. 22% patients underwent a graft biopsy before the end of the first post transplant month (13 +/- 9.5 days). To ascertain if findings of early renal biopsy was predictive of eventual clinical outcome we analyzed renal function and blood pressure (BP) in the short and mid term. Nephrosclerosis lesions were found in 33 cases (group I) and were absent in the remaining 64 cases (group II). The 2 groups were not statistically different according to the time on dialysis, the recipient's age, the HLA matching, the cold ischemia time. The only statistically significant difference was the donor's age: 39.1 +/- 7 years in group I vs 26.9 +/- 8 years in group II (p = 0.0001). Delayed graft function was not different in the 2 groups (13 +/- 9 days group I vs 11 +/- 6 days group II). On the other hand, 30% of group I, patients required hemodialysis (9.8% in group II; p < 0.005). The incidence in graft rejection episodes was similar in both groups (50%) as well as surgical complications. Renal function was assessed by creatinine clearance at 1 and 2 years and at last follow-up visit (mean follow-up: 50.5 +/- 44 months in group I and 46.9 +/- 24 months in group II; p = Ns): it was similar in both groups (see table). The prevalence of hypertension (HTA) was significantly higher in group I than in group II at two years and last follow-up (*: p < 0.005). [table: see text]
Conclusions:
The age of donor is of importance in determining nephrosclerosis of the graft observed on early biopsies. Donor-related nephrosclerosis is a risk factor for the recipient of developing HTA without impairment of graft function in the mid term. In the context of early nephrosclerosis, the occurrence of acute rejection episode(s) is detrimental for the graft function.