Effect of Histological Damage on Long-Term Kidney Transplant Outcome

Abstract

Early transplant damage occurs in the tubulointerstitial compartment from preexisting donor kidney injury and discrete events such as vascular rejection and DGF. Subsequent chronic damage and graft failure reflect accumulated previous injury and chronic interstitial fibrosis, vascular impairment, subclinical rejection, and injury from late rejection. CAN may be conceptualized as the sequelae of incremental and cumulative damage to the transplanted kidney. The duration of graft survival is dependent and predicted by the quality of the transplanted donor kidney combined with the intensity, frequency, and irreversibility of these damaging insults.

Correlation of Quantitative Digital Image Analysis with the Glomerular Filtration Rate in Chronic Allograft Nephropathy

“…This finding is in agreement with a previous study of 156 patients biopsied for clinical suspicion of CAN, in which the presence of arterial wall thickening was not predictive of graft outcome (8). In the current study, our findings do not rule out the possibility, raised by other reports, that the relationship between vascular pathology and renal outcome in patients prior to the development of clinically apparent CAN, may be of prognostic significance (22,34).…”

“…Chronic allograft nephropathy is a multifactoral process that constitutes the leading cause of late renal allograft failure (1,(19)(20)(21)(22). Despite this association with late graft injury, it is clear that histopathologic alterations of CAN are present in up to two-thirds of kidneys transplants as early as 2 years after transplantation (20) and may occur in the absence of discernible alterations in renal function (5,23,24).…”

Evaluation of the Effect of Tofacitinib Exposure on Outcomes in Kidney Transplant Patients

“…An alternative explanation could be the avoidance of the vasoconstrictive effect of CsA. However, early findings of IF/TA have been associated with impaired graft survival (22). The higher renal function and reduced structural allograft injury may suggest benefit from the use of tofacitinib in kidney transplant patients if these observations are confirmed in longer-term studies.…”

Ureteric Lesions Detected in Normally Functioning Kidney Allografts: Risk Factors and Clinical Implications

“…7,9 The detection of borderline or AR lesions mostly in early biopsies, with a decline afterward, is also observed on routine renal biopsies. 7,8,10 The low incidence of ureteral complications, with two of the fistulae having occurred before the biopsy date, may justify the absence of any significant correlation. The absence of relation between the findings in these biopsies and those done at the time of transplantation is somewhat unexpected.…”