title: The presence of glomerular sclerosis at time zero has a significant impact on function after cadaveric renal transplantation.
abstract: BACKGROUND
  The aim was to determine the impact of donor glomerulosclerosis on allograft outcome.
  
  
  METHODS
  The percentage of glomerular sclerosis (%GS) was calculated in protocol biopsies taken at engraftment. Clinical variables were obtained from the Welsh Transplantation Research Group (WTRG) database.
  
  
  RESULTS
  Of 210 allografts, 129 showed %GS=0, but 81 kidneys showed %GS between 1 and 60. Patients with %GS=0 had the highest glomerular filtration rate (GFR) at 1 year (62.0 mL/min) and the slowest deterioration of function (-3.8 mL/min per year). Patients with %GS greater than 20 had the lowest GFR at 1 year (36.0 mL/min) and the steepest rate of deterioration (-9.0 mL/min per year). The %GS of 10 alone can reduce GFR at 4 years by 8 mL/min, a similar reduction to a single rejection episode or an increase in donor age of 30 years. Actuarial 5-year graft survival for %GS=0 was 80%, and for %GS greater than 20 was 35% ( P=0.04).
  
  
  CONCLUSIONS
  The findings indicate that a biopsy taken at procurement will provide information for the most appropriate allocation of a kidney.
authors.affiliation: Welsh Transplantation Research Group, University of Wales College of Medicine, Cardiff, United Kingdom.
authors.forename: Xavier
authors.initials: X
authors.lastname: Escofet
authors.forename: Hisham
authors.initials: H
authors.lastname: Osman
authors.forename: David F R
authors.initials: DF
authors.lastname: Griffiths
authors.forename: Suzanna
authors.initials: S
authors.lastname: Woydag
authors.forename: W
authors.initials: W
authors.lastname: Adam Jurewicz
mesh_terms: D001706:Biopsy; D005923:Glomerulosclerosis, Focal Segmental / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D009927:Tissue and Organ Procurement / Q000592:standards*; D014184:Transplantation, Homologous