GLOMERULOSCLEROSIS AS A DETERMINANT OF POSTTRANSPLANT FUNCTION OF OLDER DONOR RENAL-ALLOGRAFTS

Transplantation of kidneys from older donors is being advocated to exp and the organ donor pool, However, the prevalence of atherosclerosis a nd age-induced renal structural alterations account for the variable f unction of allografts procured from these older donors. Pretransplant biopsies are sometimes used to evaluate kidneys from older donors, but to date there are no defined criteria correlating the extent of struc tural alterations in these kidneys to subsequent function, We investig ated the effect of glomerulosclerosis, a marker for nephrosclerosis, o n graft outcome. Sixty-five baseline biopsies of kidney allografts wer e retrospectively analyzed to identify a referent point of glomerulosc lerosis that correlated with inferior graft outcome. Age and death fro m nontraumatic cerebrovascular injuries were the main correlates for d onor glomerulosclerosis (P<0.001). Allografts with poor function at 6 months defined as serum creatinine >2.5 mg/dl (n=13) or nephrectomy (n =4) had a mean of 20% glomerulosclerosis at the time of implantation c ompared with only 2% sclerosis in allografts with good function (P<0.0 5). Delayed graft function occurred in 22% and 33% of recipients with no glomerulosclerosis and those with less than 20% glomerulosclerosis, respectively, In contrast, patients receiving kidneys with >20% scler osis had an 87% incidence of delayed function (P<0.05). Moreover, graf t loss occurred in 7% of recipients of kidneys with less than 20% scle rosis and in 38% of recipients with >20% sclerosis (P<0.04). Measureme nts of serum creatinine in the donors did not distinguish the differen t degrees of glomerulosclerosis found on biopsy, Our data indicate tha t donor glomerulosclerosis greater than 20% increases the risk of dela yed graft function and poor outcome of transplanted kidneys. Therefore , we advocate the use of routine biopsies of kidneys from older (>50 y rs) donors and those donors with nontraumatic cerebrovascular accident s, despite seemingly normal preprocurement serum creatinine.