CLINICAL IMPLICATIONS OF THE DIAGNOSIS OF RENAL-ALLOGRAFT INFARCTION BY PERCUTANEOUS BIOPSY

Background. Herein we investigated the relationships between acute rej ection (AR), infection, and renal allograft infarcts, particularly tho se infarcts that occur beyond the immediate posttransplant period and that affect functioning grafts. Methods, Infarcts (n=59) were classifi ed as: (1) early (EI; <2 months after transplant; n=32); or (2) late ( LI; >2 months; n=27), Controls included patients with severe AR but wi thout infarction (n=84), Results. There were not significant differenc es in donor or recipient characteristics between infarcts and controls . At diagnosis, patients with infarcts were more likely to be infected (30%) than controls (14%, P=0.01); 15% of infarcts and 1% of controls had disseminated cytomegalovirus (P=0.04). Infarct and AR coexisted i n the biopsy specimens of 66% of patients with EI and 62% of patients with LI, but the AR severity ranged from borderline to severe. Further more, 30% of patients with EI/LI had a history of severe AR. Graft sur vival was 47% in patients with EI, 22% in patients with LI (NS), and 7 1% in controls (P<0.0001, chi-square and Cox regression). Correlates o f better graft survival in infarcts included: older recipient (P=0.03) ; smaller area of infarction in the biopsy specimen (P=0.04); and use of anti-AR therapy (P=0.03), Therapy was effective in patients with EI (treated, 71% survival; untreated, 29%, P=0.02) but not in patients w ith LI (25% vs. 23%), Conclusions. Allograft infarcts are associated w ith AR in 64% of patients, but the AR may be mild. Infarcts are associ ated with infections. Graft survival is worse in patients with infarct s than in patients with severe AR, consequently these two pathologic d iagnoses should not be considered as a single entity.