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 dono r kidney transplant recipients were blindly reevaluated by our nephrop athologist, and individual lesions were evaluated semiquantitatively. Glomerular lesions included capillary thrombosis, cellular infiltrate, mesangial matrix thickening, glomerulonephritis and the presence of g lomerular crescents. Tubulointerstitial lesions included tubular necro sis, tubulitis, tubular atrophy, interstitial hemorrhage, interstitial inflammatory cellular infiltrate and infarction. Vascular lesions inc luded endovasculitis, arteriolar wall fibrinoid necrosis and intimal f ibrosis. Graft outcome was assessed by looking for the changes in seru m creatinine at 3 months postbiopsy and regularly every 3 months until . 36 months thereafter. Other variables were considered including pati ent age, timing of biopsy posttransplantation, and type of immune supp ression. Statistical analyses were performed to study the impact of ea ch individual lesion on graft outcome as judged by changes in serum cr eatinine. Furthermore, models were constructed for short- and long-ter m graft outcome. Arteriolar wall fibrinoid necrosis, tubular necrosis, glomerular capillary thrombosis and increased mesangial matrix thickn ess were the most serious lesions affecting graft outcome.