Fibrous Intimal Thickening at Implantation as a Risk Factor for the Outcome of Cadaveric Renal Allografts1

Bosmans, Jean‐Louis; Woestenburg, Annemie; Ysebaert, Dirk; Chapelle, Thierry; Helbert, Mark; Corthouts, R.; Jürgens, Angelika; Daele, A. Van; Marck, Eric A. Van; Broe, Marc E. De; Verpooten, Gert A.

doi:10.1097/00007890-200006150-00030

Cited by 63 publications

(46 citation statements)

References 38 publications

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“…Recently, we have observed in 3-month protocol biopsies, that the presence of CAN associated with transplant vasculopathy (cv-score Ն1), implies a poorer allograft survival than CAN without vessel involvement (10). Data obtained from the study of donor biopsies further sustain the notion that vessel narrowing is a major determinant of outcome (11,12). Taken together, these observations suggested that the presence of chronic renal damage in protocol biopsies associated or not with chronic vascular damage, could be considered a primary efficacy variable in a hypothetical trial aimed to prevent CAN.…”

Section: Introductionmentioning

confidence: 56%

“…Recently, it has been documented in 4-month protocol biopsies that CAN associated with transplant vasculopathy implies a poorer prognosis than CAN without vessel narrowing (10). Furthermore, an association between pre-existing chronic vascular damage in the donor and decreased renal allograft survival has been described (11,12). These observations point out the importance of renal transplant vasculopathy as a major predictor of outcome and raise the question whether protocol biopsies could be employed to monitor the appearance and progression of transplant vasculopathy in the kidney in a similar way to how intracoronary ultrasounds have been employed in the heart (25).…”

Section: Discussionmentioning

confidence: 99%

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Serial Protocol Biopsies to Quantify the Progression of Chronic Transplant Nephropathy in Stable Renal Allografts

Moreso

López

Vallejos

et al. 2001

American Journal of Transplantation

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Aim: To evaluate the utility of intimal thickness and interstitial width as a primary efficacy variable in the design of clinical trials aimed to modify the natural history of chronic allograft nephropathy. Methods: A donor and a 4-month protocol biopsy were evaluated in 40 stable grafts according to the Banff schema. In 27 patients, a second protocol biopsy was done at 1 yr. Arterial intimal volume fraction (Vvintima/ artery) and cortical interstitial volume fraction (Vvinterstitium/cortex) were estimated with a point counting technique. Results: Chronic Banff scores increased during followup, while acute scores reached its peak at 4 months. Vvintima/artery and Vvinterstitium/cortex significantly increased at 4 months, but not at 1 yr. Vvintima/artery at 4 months correlated with donor Vvintima/artery (r Ω0.57, p ∞0.001), histocompatibility (r Ω0.38, p Ω 0.01) and serum cholesterol (r Ω0.31, p Ω0.047). Vvinterstitium/cortex at 4 months correlated with recipient body surface area (r Ω0.44, p Ω0.004) and delayed graft function (p Ω0.016). Power calculations showed that Vvintima/artery and Vvinterstitium/cortex allow an important reduction in minimum sample size of a hypothetical trial aimed to prevent chronic allograft nephropathy. Conclusions: Intimal thickening and interstitial widening progresses rapidly during the first 4 months after transplantation and slowly thereafter. These parameters can be considered as a primary efficacy variable in trials aimed to prevent chronic allograft nephropathy.

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Section: Introductionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Serial Protocol Biopsies to Quantify the Progression of Chronic Transplant Nephropathy in Stable Renal Allografts

Moreso

López

Vallejos

et al. 2001

American Journal of Transplantation

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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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“…Nyberg Another approach to identifying high-risk kidneys is to use a pre-implantation biopsy in order to characterize potential kidney grafts (8), help predict the graft outcome (9,10), and provide a reference point for analysis of subsequent biopsies (8,11). The percentage of sclerotic glomeruli (9,12) and the degree of tubulointerstitial (12,13) and chronic vascular lesions (10,(14)(15)(16)(17)(18)(19) Neither clinical donor risk score (Nyberg or Pessione) showed an association with a low eGFR at 1 year (Table 2).…”

Section: The Continuing Shortage Of Organ Donors Has Led To Increasinmentioning

confidence: 99%

A Simple Clinico-Histopathological Composite Scoring System Is Highly Predictive of Graft Outcomes in Marginal Donors

Anglicheau

Loupy

Lefaucheur

et al. 2008

American Journal of Transplantation

116

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Fibrous Intimal Thickening at Implantation as a Risk Factor for the Outcome of Cadaveric Renal Allografts1

Abstract: Fibrous intimal thickening at implantation is a determinant risk factor for the functional and morphologic outcome of cadaveric renal allografts at 1 1/2 years.

Cited by 63 publications

References 38 publications

Serial Protocol Biopsies to Quantify the Progression of Chronic Transplant Nephropathy in Stable Renal Allografts

Serial Protocol Biopsies to Quantify the Progression of Chronic Transplant Nephropathy in Stable Renal Allografts

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

A Simple Clinico-Histopathological Composite Scoring System Is Highly Predictive of Graft Outcomes in Marginal Donors

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