Presence of arteriolar hyalinosis in post-reperfusion biopsies represents an additional risk to ischaemic injury in renal transplant

Presence of arteriolar hyalinosis in post-reperfusion biopsies represents an additional risk to ischaemic injury in renal transplant

Author Matos, Ana Cristina Google Scholar
Câmara, Niels Olsen Saraiva Autor UNIFESP Google Scholar
Requiao-Moura, Lucio R. Google Scholar
Tonato, Eduardo J. Google Scholar
Filiponi, Thiago C. Google Scholar
Souza-Durao, Marcelino, Jr. Google Scholar
Malheiros, Denise M. Google Scholar
Fregonesi, Mauricio Google Scholar
Borrelli, Milton Google Scholar
Pacheco-Silva, Alvaro Autor UNIFESP Google Scholar
Abstract Aim: 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 < 60mL/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%. AHwas 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 x 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). Conclusion: 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.
Keywords chronic allograft nephropathy
glomerular filtration rate
ischaemia-reperfusion
pathology
renal
renal biopsy
transplantation
xmlui.dri2xhtml.METS-1.0.item-coverage Hoboken
Language English
Date 2016
Published in Nephrology. Hoboken, v. 21, n. 11, p. 923-929, 2016.
ISSN 1320-5358 (Sherpa/Romeo, impact factor)
Publisher Wiley-Blackwell
Extent 923-929
Origin http://dx.doi.org/10.1111/nep.12699
Access rights Closed access
Type Article
Web of Science ID WOS:000385715400003
URI https://repositorio.unifesp.br/handle/11600/56841

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