title: Kidney allograft fibrosis after transplantation from uncontrolled circulatory death donors.
abstract: BACKGROUND
  Existing data suggest that increased interstitial fibrosis may occur abnormally in renal transplants from donations after uncontrolled circulatory death (uDCD).
  
  
  METHODS
  To evaluate the factors that are associated with the progression of fibrosis and its functional impact on renal grafts, we compared 76 uDCD recipients with 86 recipients of kidney donations after brain death at 1-year after transplantation. Groups were matched for donor age, rank of transplantation, and absence of human leukocyte antigen sensitization. Histology was performed on sequential biopsies in uDCD recipients. Associations between variables were analyzed using linear mixed models and univariate analyses.
  
  
  RESULTS
  In the uDCD group, increased fibrosis was detected 3 months after transplantation compared to before implantation. After 1 year, interstitial fibrosis and tubular atrophy score was significantly greater (1.5±0.7 vs. 1.0±0.9; P=0.003) and estimated glomerular filtration rate (49.5±17.4 vs. 60.6±19.1 mL/min/1.73 m2; P=0.0003) was significantly lower in the uDCD group than in the donations after brain death group. No flow duration and donor age were significantly associated with accelerated fibrosis. Interstitial fibrosis and tubular atrophy score, interstitial inflammation score, and estimated glomerular filtration rate were significantly worse in uDCD patients with no flow longer than 10 min.
  
  
  CONCLUSIONS
  Donations after uncontrolled circulatory death grafts show more fibrosis after transplantation. No flow duration is associated with accelerated fibrosis and should be considered during uDCD graft allocation.
authors.affiliation: 1 Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 2 Department of Pathology, Georges Pompidou European Hospital, Paris, France. 3 Biostatistics Unit, Paris Cardiovascular Research Centre, L'Université Paris Descartes, Paris, France. 4 Surgical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 5 Department of Pathology, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 6 Department of Urology, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 7 Department of Kidney Transplantation, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. † Deceased.
authors.forename: Denis
authors.initials: D
authors.lastname: Viglietti
authors.forename: Imad
authors.initials: I
authors.lastname: Abboud
authors.forename: Gary
authors.initials: G
authors.lastname: Hill
authors.forename: Dewi
authors.initials: D
authors.lastname: Vernerey
authors.forename: Dominique
authors.initials: D
authors.lastname: Nochy
authors.forename: Corinne
authors.initials: C
authors.lastname: Antoine
authors.forename: Fabienne
authors.initials: F
authors.lastname: Fieux
authors.forename: Maureen
authors.initials: M
authors.lastname: Assayag
authors.forename: Jérôme
authors.initials: J
authors.lastname: Verine
authors.forename: François
authors.initials: F
authors.lastname: Gaudez
authors.forename: Alexandre
authors.initials: A
authors.lastname: Loupy
authors.forename: Denis
authors.initials: D
authors.lastname: Glotz
authors.forename: Carmen
authors.initials: C
authors.lastname: Lefaucheur
mesh_terms: D000328:Adult; D000367:Age Factors; D064591:Allografts; D001284:Atrophy; D001706:Biopsy; D001775:Blood Circulation; D001926:Brain Death; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology; D050377:Cold Ischemia / Q000009:adverse effects; D046148:Donor Selection; D005260:Female; D005355:Fibrosis; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000009:adverse effects