title: Presence of arteriolar hyalinosis in post-reperfusion biopsies represents an additional risk to ischaemic injury in renal transplant.
abstract: OBJECTIVE
  The role of post-reperfusion biopsy findings as a predictor of early and long-term graft function and survival is still a target of research.
  
  
  METHODS
  We analyzed data from 136 post-reperfusion biopsies performed in deceased donor renal transplanted patients from November 2008 to May 2012. We analyzed the presence of acute tubular necrosis (ATN), arteriolar hyalinosis (AH), intimal thickness (IT), interstitial fibrosis (IF) and glomerulosclerosis (GS). We also analyzed the impact of donor features on the following outcomes: delayed graft function (DGF) and chronic allograft dysfunction defined as eGFR < 60 mL/min at 1 year.
  
  
  RESULTS
  The mean donor age was 41 years, 26% of whom were extended criteria donors (ECD), 33% had hypertension and 50% had cerebral vascular accident (CVA) as the cause of death. ATN was present in 87% of these biopsies, AH in 31%, IF in 21%, IT in 27% and GS in 32%. DGF occurred in 80% and chronic allograft dysfunction was present in 53%. AH was the only histological finding associated with DGF and chronic allograft dysfunction at 1 year. Patients with AH had a lower eGFR at 1 year than patients without it (49.8 mL/min × 64.5 mL/min, P = 0.02). In the multivariate analysis, risk variables for development of chronic graft dysfunction were male sex (odds ratio [OR] = 3.159 [CI: 1.22-8.16]; P = 0.018), acute rejection (OR = 8.91 [CI: 2.21-35.92]; P = 0.002), donor hypertension (OR = 2.94 [CI: 1.10-7.84]; P = 0.031), AH (OR = 3.96 [CI: 1.46-10.70]; P = 0.007) and eGFR at discharge (OR = 0.96 [CI: 0.93-0.98]; P = 0.005). In multivariate analysis, risk factors for AH were donor age ≥ 50 years (OR = 2.46 [CI: 1.10-5.44]; P = 0.027) and CVA as the cause of donor death (OR = 2.33 [CI: 1.05-5.15]; P = 0.007).
  
  
  CONCLUSIONS
  The presence of AH in post-reperfusion biopsies is a marker of ageing and vascular disease and was associated with DGF and a one year poorer renal function. AH in donor biopsies superimposed to long ischaemic time is a predictor of renal function. The management of immunosuppression based on the presence of AH in post-reperfusion biopsy could be useful to improve long term graft function.
authors.affiliation: Renal Transplant Division, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil. accmatos@einstein.br.
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Matos
authors.affiliation: Nephrology Department, Federal University of São Paulo, São Paulo, Brazil.|Immunology Department, São Paulo University, São Paulo, Brazil.
authors.forename: Niels O
authors.initials: NO
authors.lastname: Câmara
authors.affiliation: Renal Transplant Division, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
authors.forename: Lúcio R
authors.initials: LR
authors.lastname: REQUIãO-Moura
authors.affiliation: Renal Transplant Division, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
authors.forename: Eduardo J
authors.initials: EJ
authors.lastname: Tonato
authors.affiliation: Renal Transplant Division, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
authors.forename: Thiago C
authors.initials: TC
authors.lastname: Filiponi
authors.affiliation: Renal Transplant Division, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
authors.forename: Marcelino
authors.initials: M
authors.lastname: Souza-DURãO
authors.affiliation: Pathology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Malheiros
authors.affiliation: Renal Transplant Division, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
authors.forename: Maurício
authors.initials: M
authors.lastname: Fregonesi
authors.affiliation: Renal Transplant Division, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
authors.forename: Milton
authors.initials: M
authors.lastname: Borrelli
authors.affiliation: Renal Transplant Division, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.|Nephrology Department, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pacheco-Silva
mesh_terms: D000328:Adult; D050379:Arteriolosclerosis / Q000378:metabolism / Q000473:pathology; D001706:Biopsy / Q000379:methods; D051799:Delayed Graft Function / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D006818:Hyalin / Q000378:metabolism; D007165:Immunosuppression Therapy / Q000379:methods; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D007683:Kidney Tubular Necrosis, Acute / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D008297:Male; D015427:Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control; D012307:Risk Factors; D013997:Time Factors
keywords: chronic allograft nephropathy; glomerular filtration rate; ischaemia-reperfusion; pathology; renal; renal biopsy; transplantation