© 2018 Wolters Kluwer
P.049
The Effect of Chronic Lesions in Implantation Biopsy on the
Function and Survival of Renal Grafts from Donation after Cardiac
Death Donors
Xiao-Peng Yuan, Yi-Tao Zheng, Chuan-Bao Chen, Chang-Xi Wang
Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen
University, Guangzhou, People's Republic of China.
Background: Baseline chronic donor kidney injury is usually scored using
Remuzzi’s classification. It has been suggested that kidneys with Remuzzi
scores of 0-3 can be transplanted singly. The kidney function and graft sur-
vival of renal grafts from donation after cardiac death (DCD) donors with
Remuzzi scores of 4-5 in solitary kidney transplantation is unknown. Methods
Preimplant kidney biopsy for 145 consecutive, solitary, DCD kidneys transplanted
at our center from July 2013 to December 2016 was retrospectively reviewed.
Kidneys with Remuzzi scores of 4-5 were accepted for solitary kidney
transplantation in our center if the donors’ terminal serum creatinine clear-
ance > 60 ml/min (Cockcroft formula).
Results: The 12 months estimated glomerular filtration rate (eGFR, by the
CKD-EPI equation) of renal grafts with Remuzzi score of 0-3 was significantly
higher than grafts with Remuzzi score of 4-5 (76.3 ± 21.4 ml/min vs. 44.0 ±
10.9 ml/min,P<0.001). The 12 months eGFR of renal grafts with Remuzzi
score of 3 was significantly higher than grafts with Remuzzi score of 4 or 5
(P<0.01) . With a follow-up of 14-40 months, Kaplan-Meier analysis showed
that there were no statistical differences in graft survival between kidneys with
Remuzzi score 0-3 and 4-5.
Conclusions: Kidneys from DCD donors with Remuzzi score 4-5 have
worse graft function at one year after solitary kidney transplantation but with
acceptable short-term graft survival.
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Abstracts S489
P.050
Risk Factors for Transplant Vasculopathy in Kidney Transplant
Nora C Imperiali1, Maria C Giordani1, Silvia R Groppa1, Cesar Mombelli1,
Susana K Villamil Cortez1, Damian O Fabriani1, Melisa M Galarza Hanglin1,
Maria L Ocampo1, Silvia B Christiansen2, Guillermo J Rosa Diez1
1
Nephrology, Hospital Italiano, CAPITAL FEDERAL, Argentina;
2
Pathology, Hospital Italiano, CAPITAL FEDERAL, Argentina.
Introduction: Transplant vasculopathy(Tv) is a confusing term that included
endarteritis,atherosclerosis, and allograft arteriopathy. Kidney transplant is a
model for the antibody-dependent and independent immune vascular injury.
It is often more severe or “accelerated” than expected based on the age of
the donor and could lead to graft loss.The aim of this study is to evaluated
the presence of transplant vasculopathy in kidney transplant biopsies and risk
factors associated.
Methods: This retrospective study included 239 allograft biopsies for cause
in 112 kidney transplant recipient from 2015 to 2016. All biopsies, with and
without transplant arteriopathy, donor, recipient and transplant proper vari-
ables were analyzed.
Statistical Analysis: All data are expressed as mean ± standard deviation
or proportions, unless otherwise indicated. Considering the presence of vas-
culopathy as dependent variable we performed a univariate analysis with
the others variables. Unpaired ‘t’ test was used for those normally distributed
variables whereas the Fisher exact test was used for comparison of count var-
iables. A a P-value ≤ 0.05 was considered statistically significant. All vari-
ables that had statistical significance were included in a multiple logistic
regression model.
Results: Transplant vasculopathy was found in 55/112 patients (52.9%) Re-
cipient age was 46 (18-75 ) years,sixty were men, 41% were sensitized and
10% were hypersensitized. Donor age was 42.98 (11-72) years, 58 males,
61(56%) were deceased donor and 11 met expanded criteria(10%). In
54.23% cerebrovascular/stroke was the cause of death among deceased
donors (CVA-Death), 15% were hypertensive and two were diabetic. Mean Is-
chemic time was 19 ± 5 hours. In univariate analysis transplant vasculopathy
was correlated with donor age : 60% positive in patient >45 years vs 35% in
patients <35 years, donor males 59% vs 34 % ( p<0.03.). In cadaveric donors
with vascular brain accident as death cause Transplant vasculopathy was
found in 64.3% of biopsies vs only in 10% of donor traumatic brain death
(p<0.004). As regards immunological factors: in biopsies consistent with
microcirculation injury(IM) vascular injury was present in 62.3 %vs 34% in bi-
opsies without inflammation (p< 0.0001).In multivariate analysis only micro-
vascular injury results significative.
Conclusion: In this study risk factors associated with develop of transplant
vasculopathy in kidney allograft biopsies were: older and male donors, vascu-
lar brain accident as death cause and microcirculation injury in graft biopsies.