Comparison of renal allograft fibrosis after transplantation from heart-beating and non-heart-beating donors

Bains, J; Sandford, R.M; Brook, N R; Hosgood, Sarah A.; Lewis, G; Nicholson, M. L.

doi:10.1002/bjs.4777

Cited by 21 publications

(13 citation statements)

References 22 publications

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“…Recently, a similar incidence and severity of interstitial fibrosis in surveillance biopsies from living-and deceased-donor kidneys was found, challenging the impact of injury related to brain death and/or prolonged preservation (14). In addition, protocol biopsies of kidneys from a heartbeating or non-heart-beating donor revealed no significant difference in quantitative Sirius red staining in relation to prolonged periods of warm ischemia (31).…”

Section: Discussionmentioning

confidence: 92%

Untreated Rejection in 6-Month Protocol Biopsies Is Not Associated with Fibrosis in Serial Biopsies or with Loss of Graft Function

Scholten

Rowshani²,

Cremers³

et al. 2006

Journal of the American Society of Nephrology

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Donor age, calcineurin inhibitor nephrotoxicity, and acute rejection are the most significant predictors of chronic allograft nephropathy. Protocol biopsies, both in deceased-and living-donor renal grafts, have shown that cortical tubulointerstitial fibrosis correlates with graft survival and function. The impact of not treating subclinical acute rejection (SAR) is less clear. In this study, 126 de novo renal transplant recipients were randomly assigned to receive area-under-the-curve-controlled exposure of either a cyclosporine or a tacrolimus-based immunosuppressive regimen that included steroids, mycophenolate mofetil, and basiliximab induction. Protocol biopsies were taken before and 6 and 12 mo after transplantation. The prevalence of SAR was determined retrospectively. Fibrosis was evaluated by quantitative digital analysis of Sirius red staining in serial biopsies. Donor age correlated significantly with tubulointerstitial fibrosis in pretransplantation biopsies and inferior graft function at month 6 (r ‫؍‬ ؊0.26; P ‫؍‬ 0.033). Acute rejection incidence was 11.5%, and no clinical late rejection occurred. The prevalence of SAR at 6 mo was 30.8% but was not associated with differences in serial quantitative Sirius red staining at 6 or 12 mo, proteinuria, or progressive loss of GFR up to 2 yr. No differences were found in donor variables, histocompatibility, rejection history, or exposure of immunosuppressants. Controlled individualized calcineurin inhibitor exposure and subsequent tapering resulted in a low early acute rejection rate and prevented late acute rejection. Because, by design, we did not treat SAR, these results provide evidence that asymptomatic infiltrates in 6-mo surveillance biopsies may not be deleterious in the intermediate term. There is need for reliable biomarkers to prove that not all cell infiltrates are equivalent or that infiltrates may change with time.

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Section: Discussionmentioning

confidence: 92%

Untreated Rejection in 6-Month Protocol Biopsies Is Not Associated with Fibrosis in Serial Biopsies or with Loss of Graft Function

Scholten

Rowshani²,

Cremers³

et al. 2006

Journal of the American Society of Nephrology

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“…A study from the authors' unit found no difference in the levels of fibrosis between NHBD and HBD kidneys 11 . However, this was based only on biopsies taken up to 12 months after transplantation.…”

Section: Discussionmentioning

confidence: 98%

Case-matched comparison of long-term results of non-heart beating and heart-beating donor renal transplants

Barlow

Metcalfe

Johari

et al. 2009

British Journal of Surgery

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“…The use of marginal donors is usually met with skepticism and subject to generalization and inappropriate The negative impact of donor vasculopathy has been stressed in some studies (17)(18)(19)(20)(21)(22)(23)(24) although questioned by others (25). …”

Section: Discussionmentioning

confidence: 99%

The Maryland Aggregate Pathology Index: A Deceased Donor Kidney Biopsy Scoring System for Predicting Graft Failure

Munivenkatappa¹,

Schweitzer²,

Papadimitriou³

et al. 2008

American Journal of Transplantation

136

134

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Despite the common use of diagnostic pretransplant deceased donor kidney biopsy, there is no consensus on the prognostic significance of the pathologic findings. In order to assist clinicians with interpretation we analyzed 371 pretransplant biopsies and correlated the findings with graft failure. Glomerular pathology was assessed with percent glomerulosclerosis (GS), glomerular size and periglomerular fibrosis (PGF); vascular pathology with arterial wall-to-lumen ratio (WLR) and arteriolar hyalinosis and interstitial pathology with measurement of cumulative fibrosis and presence of scar. Using two-thirds of the study population as a model-development cohort, we found that biopsy features independently associated with an increased risk of graft failure were GS ≥15%, interlobular arterial WLR ≥0.5 and the presence of PGF, arteriolar hyalinosis or scar. The Maryland Aggregate Pathology Index (MAPI), was developed from these parameters and validated on the remaining one-third of the population. Five-year actuarial graft survival was 90% for kidneys with MAPI scores between 0 and 7, 63% for scores from 8 to 11 and 53% for scores from 12 to 15 (p < 0.001). We conclude MAPI may help transplant physicians estimate graft survival from the preimplantation biopsy findings, in clinical situations similar to this study population (cold ischemia over 24 h, GS < 25%).

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Comparison of renal allograft fibrosis after transplantation from heart-beating and non-heart-beating donors

Cited by 21 publications

References 22 publications

Untreated Rejection in 6-Month Protocol Biopsies Is Not Associated with Fibrosis in Serial Biopsies or with Loss of Graft Function

Untreated Rejection in 6-Month Protocol Biopsies Is Not Associated with Fibrosis in Serial Biopsies or with Loss of Graft Function

Case-matched comparison of long-term results of non-heart beating and heart-beating donor renal transplants

The Maryland Aggregate Pathology Index: A Deceased Donor Kidney Biopsy Scoring System for Predicting Graft Failure

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