title: Protocol biopsies in kidney transplant recipients: histologic findings as prognostic markers for graft function and outcome.
abstract: The aim of the present study was to identify subclinical and borderline rejections as well as histological markers of chronic allograft nephropathy (CAN) among protocol biopsies performed at 1 and 6 months after living related kidney transplantation to assess their possible implications for graft function. Twenty paired allograft biopsies performed at 1 and 6 months were reviewed according to the Banff scoring scheme. The mean ages of donors and recipients were 59.6 +/- 13.8 and 34.4 +/- 8.7 years, respectively. Among all biopsies only 10% (4/40) showed no histopathological lesions. At the first month borderline rejection was shown in 35% and subclinical rejection in 10% of patients. At 6 months the proportion of findings was even higher, namely, 40% and 30%, respectively. When divided according to donor age, donors above 55 years showed a mean CAN score of 2.33 +/- 1.56 which increased to 5.0 +/- 2.26 on the 6 month biopsy (214.3%). Unexpectedly, the proportion of these changes in the younger donor group also increased by 173.3%, which might have been explained by the greater number of borderline and subclinical rejections in the younger donor group at the 1 month biopsy. In conclusion, 1 month biopsy may be valuable to determine borderline and subclinical rejection and to prognosticate the outcome of renal allograft function. Our findings suggest a greater susceptibility of histological deterioration among the older donor population. However, the presence of an untreated rejection in the younger donor pool leads to a rapid impairment of the graft function accelerating the process of chronic allograft nephropathy.
authors.affiliation: Department of Nephrology, Clinical Center Skopje, University of Skopje, Skopje, Macedonia.
authors.forename: J
authors.initials: J
authors.lastname: Masin-Spasovska
authors.forename: G
authors.initials: G
authors.lastname: Spasovski
authors.forename: S
authors.initials: S
authors.lastname: Dzikova
authors.forename: L
authors.initials: L
authors.lastname: Grcevska
authors.forename: G
authors.initials: G
authors.lastname: Petrusevska
authors.forename: Lj
authors.initials: Lj
authors.lastname: Lekovski
authors.forename: Z
authors.initials: Z
authors.lastname: Popov
authors.forename: N
authors.initials: N
authors.lastname: Ivanovski
mesh_terms: D000328:Adult; D000367:Age Factors; D001706:Biopsy / Q000379:methods; D002908:Chronic Disease; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000145:classification / Q000473:pathology*; D006801:Humans; D016030:Kidney Transplantation / Q000473:pathology* / Q000502:physiology; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria; D013997:Time Factors; D014184:Transplantation, Homologous / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D003404:Creatinine