Jl. Bosmans et al., Fibrous intimal thickening at implantation as a risk factor for the outcome of cadaveric renal allografts, TRANSPLANT, 69(11), 2000, pp. 2388-2394
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.