Fibrous intimal thickening at implantation as a risk factor for the outcome of cadaveric renal allografts

Background During the past decade, the donor age of cadaveric renal allogra fts steadily increased, Because cerebrovascular injury is the main cause of death in this donor population, an increased prevalence of atherosclerotic lesions in the retrieved grafts could be anticipated. In a prospective stu dy, we investigated the predictive value of morphologic lesions at implanta tion for the functional and morphologic outcome of cadaveric renal allograf ts at 11/2 years. Methods. In 50 consecutive adult recipients of a cadaveric renal allograft, under cyclosporine-based regimen, implantation biopsies and subsequent pro tocol biopsies at 18 months were performed, and morphometrically analyzed f or the extent of glomerulosclerosis, interstitial fibrosis, and atheroscler osis. Risk factors were assessed at implantation and during the subsequent observation period of 18 months. Endpoints for this study were: the 24-hr c reatinine clearance (normalized for body surface area) and the fractional i nterstitial volume at 11/2 years. Results. In multivariate analysis, fibrous intimal thickening at implantati on (FIT) was the main determinant of the functional and morphologic outcome at 11/2 years. FIT represented a relative risk of 4.55 for interstitial fi brosis (95% CI=1.855-11.138), and 1.89 for impaired renal function (95% CI= 1.185-3.007) at 11/2 years. FIT adversely affected fractional interstitial volume at 11/2 years (34.3 vs. 27.7%, P=0.004), as well as renal function ( 54 vs. 68 ml/min/1.73 m(2), P=0.028). Conclusions. Fibrous intimal thickening at implantation is a determinant ri sk factor for the functional and morphologic outcome of cadaveric renal all ografts at 11/2 years.