The presence of glomerular sclerosis at time zero has a significant impact on function after cadaveric renal transplantation.
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.
Escofet
Xavier
X
Welsh Transplantation Research Group, University of Wales College of Medicine, Cardiff, United Kingdom.
Osman
Hisham
H
Griffiths
David F R
DF
Woydag
Suzanna
S
Adam Jurewicz
W
W
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