Study of morphologic risk factors in graft biopsies from patients with living related donor kidney transplants

In this work, 205 graft biopsies obtained from 161 living related donor kidney transplant recipients were blindly reevaluated by our nephropathologist, and individual lesions were evaluated semiquantitatively. Glomerular lesions included capillary thrombosis, cellular infiltrate, mesangial matrix thickening, glomerulonephritis and the presence of glomerular crescents. Tubulointerstitial lesions included tubular necrosis, tubulitis, tubular atrophy, interstitial hemorrhage, interstitial inflammatory cellular infiltrate and infarction. Vascular lesions included endovasculitis, arteriolar wall fibrinoid necrosis and intimal fibrosis. Graft outcome was assessed by looking for the changes in serum creatinine at 3 months postbiopsy and regularly every 3 months until 36 months thereafter. Other variables were considered including patient age, timing of biopsy posttransplantation, and type of immune suppression. Statistical analyses were performed to study the impact of each individual lesion on graft outcome as judged by changes in serum creatinine. Furthermore, models were constructed for short- and long-term graft outcome. Arteriolar wall fibrinoid necrosis, tubular necrosis, glomerular capillary thrombosis and increased mesangial matrix thickness were the most serious lesions affecting graft outcome.