Pre-existing arteriosclerotic intimal thickening in living-donor kidneys reflects allograft function.
BACKGROUND
Donor shortage is a serious problem worldwide and it is now debated whether kidneys from marginal donors are suitable for renal transplantation. Recent studies have shown that the findings of preimplantation kidney biopsy are useful to evaluate vasculopathy in the donated kidney, and may predict transplant outcomes in deceased- donor kidney transplantation. However, few studies have focused on the pathological findings of preimplantation biopsy in living-donor kidney transplantation. Therefore, we investigated whether arteriosclerotic vasculopathy in living-donor kidneys at the time of transplantation predicts the recipient's kidney function (allograft function) later in life.


METHODS
We retrospectively analyzed 75 consecutive adult living-donor kidney transplants performed at Kagawa University Hospital. Renal arteriosclerotic vasculopathy was defined according to the presence of fibrous intimal thickening in the interlobular artery.


RESULTS
Forty-one kidneys exhibited mild arteriosclerotic vasculopathy on preimplantation kidney biopsies. The decreases in estimated glomerular filtration rate after donation were similar in donors with or without renal arteriosclerotic vasculopathy. Pre-existing arteriosclerotic vasculopathy did not affect graft survival rate, patient survival rate or the incidence of complications. Recipients of kidneys with arteriosclerotic vasculopathy had lower allograft function at 1 and 3 years after transplantation than the recipients of arteriosclerosis-free kidneys with or without donor hypertension. In multivariate analysis, fibrous intimal thickening on preimplantation biopsy was predictive of reduced allograft function at 1 year after transplantation.


CONCLUSIONS
The present study demonstrated that mild arteriosclerotic vasculopathy in the donated kidney is an important pathological factor that reflects future impaired function of renal allografts from marginal donors.
Division of Nephrology and Dialysis, Department of CardioRenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan. sofue@med.kagawa-u.ac.jp
Tadashi
T
Sofue
Masashi
M
Inui
Hideyasu
H
Kiyomoto
Masahiro
M
Moritoki
Satoshi
S
Nishioka
Yoko
Y
Nishijima
Kumiko
K
Moriwaki
Taiga
T
Hara
Yoshio
Y
Kushida
Reiji
R
Haba
Takeshi
T
Yoda
Tomohiro
T
Hirao
Yoshiyuki
Y
Kakehi
Akira
A
Nishiyama
Masakazu
M
Kohno
D000368:Aged; D001161:Arteriosclerosis / Q000473:pathology* / Q000503:physiopathology; D001706:Biopsy; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000473:pathology* / Q000502:physiology; D007674:Kidney Diseases / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012077:Renal Artery / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D017539:Tunica Intima / Q000473:pathology / Q000503:physiopathology