title: Correlation of acute tubular injury in reperfusion biopsy with renal transplant outcomes.
abstract: Acute tubular injury (ATI) is common at reperfusion, but its relationship to graft outcomes is unclear. Prior studies lack standardization of morphological assessments and included elements of acute and chronic tubular injury. This study aimed to evaluate the impact of ATI on graft outcomes. Reperfusion biopsies from 2004 to 2009 were retrospectively reviewed. ATI was assessed by a new standardized scoring system. We also assessed chronic injury (CI) by the Banff criteria. Outcomes evaluated included glomerular filtration rate (GFR) at 1 and 5 years and delayed graft function (DGF), acute rejection (AR), graft and patient survival. ATI did not correlate with DGF, AR, graft or overall survival. Mild-moderate ATI was not predictive of GFR post-transplant. Moderate-severe CI was associated with lower GFR at 5 years with a mean difference of -7.14 mL/min/1.73 m(2) (P=.04) and overall survival (HR 2.44, P=.01). Other predictors of graft function included donor age, DGF, and AR. Histologic criteria of ATI at implantation in the absence of donor demographics or clinical information do not provide sufficient predictability in outcomes after transplantation. On the other hand, histologic assessment of CI correlates with GFR and overall survival.
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Yaa D
authors.initials: YD
authors.lastname: Oppong
authors.affiliation: Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Farber
authors.affiliation: Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Inna
authors.initials: I
authors.lastname: Chervoneva
authors.affiliation: Division of Nephrology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Maria P
authors.initials: MP
authors.lastname: Martinez Cantarin
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology*; D000328:Adult; D051799:Delayed Graft Function / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006084:Graft Rejection / Q000150:complications / Q000175:diagnosis*; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D007684:Kidney Tubules / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015424:Reperfusion / Q000009:adverse effects*; D012189:Retrospective Studies; D014184:Transplantation, Homologous
keywords: acute rejection; acute tubular injury; chronic injury; glomerular filtration rate; graft outcomes; graft survival; implantation biopsy; overall survival; reperfusion biopsy