Fibrous Intimal Thickening at Implantation Adversely Affects Long-Term Kidney Allograft Function

Woestenburg, Annemie; Verpooten, Gert A.; Ysebaert, Dirk; Marck, Eric A. Van; Verbeelen, Dierik; Bosmans, Jean‐Louis

doi:10.1097/tp.0b013e31818bbe06

Cited by 25 publications

(14 citation statements)

References 36 publications

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“…Previous reports have already demonstrated that organ quality at the time of donation is an important factor in determining allograft function after deceased-donor kidney transplantation [11]. Our present results showed that pre-existing mild fibrous intimal thickening in the grafts was associated with reduced allograft function, but not with renal function of the remnant donor kidney after donation.…”

Section: Discussionsupporting

confidence: 73%

“…An interlobular artery was defined as a vascular structure comprised of two or three layers of myocytes in addition to an adventitial layer and an intimal layer. To evaluate the severity of arteriosclerotic vasculopathy, we quantitatively analyzed the intima-to-media ratio (I/M ratio), as previously described [11]. We defined non-arteriosclerotic lesions as lesions with an I/M ratio <25%, mild fibrous intimal thickening in the interlobular artery as an I/M ratio of 25–50% and severe fibrous intimal thickening in the interlobular artery as an I/M ratio >50%.…”

Section: Methodsmentioning

confidence: 99%

“…It is also known from autopsy samples that the prevalence of mild arteriosclerotic vasculopathy increases with ageing [14,15]. Recently, Woestenburg et al [11] reported that the presence of vasculopathy was a useful predictor of allograft function in deceased-donor kidney transplantation. However, preimplantation biopsies were only studied for deceased donors, and no data are available for living donors.…”

Section: Introductionmentioning

confidence: 99%

“…Preimplantation biopsy is useful to evaluate the morphology and presence of vasculopathy in the grafts at the time of donation, and should provide useful parameters to predict transplant outcomes [11,12,13]. It is also known from autopsy samples that the prevalence of mild arteriosclerotic vasculopathy increases with ageing [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Pre-Existing Arteriosclerotic Intimal Thickening in Living-Donor Kidneys Reflects Allograft Function

et al. 2012

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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.

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Section: Discussionsupporting

confidence: 73%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pre-Existing Arteriosclerotic Intimal Thickening in Living-Donor Kidneys Reflects Allograft Function

et al. 2012

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“…In contrast, a previous study showed that allografts with pre-existing arteriosclerotic intimal thickening on preimplantation biopsies had lower function at 1 and 3 years after transplantation [19]. The reason for the discrepancy is unclear, but could be related to different methods for measuring intimal thickening or different patient characteristics such as recipient blood pressure which has been shown to influence the impact of pre-existing vasculopathy on graft function [20] or differences in immunosuppression. Future studies are needed to examine the interplay between donor kidney vascular disease, recipient vascular disease, and the immunosuppressive regimen in order to evaluate the relative impact of each on long-term allograft function.…”

Section: Discussioncontrasting

confidence: 40%

Prevalence of abdominal aortic calcifications in older living renal donors and its effect on graft function and histology

Wu¹,

Wojciechowski

Chandran

et al. 2015

Transpl Int

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SummaryWe assessed the prevalence of abdominal aortic calcification (AAC) in older living kidney donors and its effect on recipient eGFR and graft histology. A total of 292 consecutive living pairs with donor age ≥50 from 2003 to 2013 were identified (mean age 56; range 50-78; F/M: 1.8). Donor AAC was determined by prenephrectomy unenhanced CT. Recipient eGFR and spot urine protein: creatinine ratios (UPCRs) were recorded. A total of 180 recipients had 6-month protocol biopsies. AAC was present in 40.7% of donors, and they were older (58.6 versus 54.7 years old, P < 0.0001) and more likely to be male (77.6% vs. 37.3%, P = 0.004). There was no significant difference in eGFR or spot UPCR up to 36 months in recipients of allografts from donors with versus without AAC. At 6-month biopsy, there was a higher percentage of allografts with vascular fibrous intimal thickening and arteriolar hyaline thickening from donors with versus without AAC (vascular fibrous intimal thickening: 38.8% vs. 7.1% and arteriolar hyaline thickening: 35.8% vs. 7.1%; P < 0.001 for both). The presence of donor AAC predicts the presence of vascular disease [vascular fibrous intimal thickening (OR: 7.2; CI:2.9-17.9) and arteriolar hyaline thickening (OR:5.7; CI:2.3-14.1)] in allografts at 6 months. Donor AAC is predictive of renal vascular disease and may help to improve the screening of potential donors and inform post-transplant management.

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Kidney Transplantation: A Guide to the Care of Kidney Transplant Recipients

McKay

Steinberg²

2010

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Fibrous Intimal Thickening at Implantation Adversely Affects Long-Term Kidney Allograft Function

Cited by 25 publications

References 36 publications

Pre-Existing Arteriosclerotic Intimal Thickening in Living-Donor Kidneys Reflects Allograft Function

Pre-Existing Arteriosclerotic Intimal Thickening in Living-Donor Kidneys Reflects Allograft Function

Prevalence of abdominal aortic calcifications in older living renal donors and its effect on graft function and histology

Kidney Transplantation: A Guide to the Care of Kidney Transplant Recipients

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