Fibrous intimal thickening at implantation adversely affects long-term kidney allograft function.
BACKGROUND
Kidneys from marginal and older donors are increasingly used to respond to the increasing demand for kidney transplants. This study evaluated the predictive value of intimal hyperplasia, as a marker of vasculopathy, in the renal allograft at the time of transplantation (transplantation) on the subsequent graft function (7 years).


METHODS
The intima/media ratio of the arterial walls (I/M) was morphometrically determined by the sectorial elliptic method, in 51 implantation biopsies. Two study groups were determined. Group 1, with I/M less than or equal to 0.47, was considered as the group with minimal vascular damage at transplantation. Group 2, with I/M more than 0.47, was considered as having vasculopathy at transplantation.


RESULTS
During the first 15 months, the estimated glomerular filtration rate improved in group 1 from 53+/-17 to 61+/-17 mL/min/1.73 m2, whereas it decreased from 51+/-21 to 46+/-14 mL/min/1.73 m2 in group 2. From 1 year posttransplantation, the estimated glomerular filtration rate (eGFR) was significantly higher in group 1 at all time points (6 month evaluation). The difference in graft function between the two groups (mean, 11 mL/min/1.73 m2) remained unchanged between 1 and 7 years posttransplantation. Among several clinical parameters investigated, blood pressure of the recipient significantly modulates the impact of preexisting vasculopathy on graft function.


CONCLUSIONS
Our data provide evidence that donor-related vasculopathy, at the time of transplantation, has a persistent significant impact on the subsequent graft function. This effect becomes only apparent at 1 year posttransplantation and is increased in recipients with inadequately controlled blood pressure.
Woestenburg
Annemie T
AT
Department of Nephrology, University Hospital Brussels, Laarbeeklaan, Brussels, Belgium.
Verpooten
Gert A
GA
Ysebaert
Dirk K
DK
Van Marck
Eric A
EA
Verbeelen
Dierik
D
Bosmans
Jean-Louis
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005355:Fibrosis / Q000473:pathology / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007674:Kidney Diseases / Q000473:pathology* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D013997:Time Factors; D014184:Transplantation, Homologous