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

Abstract

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.

Recipient Outcomes Following Transplantation of Allografts From Live Kidney Donors Who Subsequently Developed End-Stage Renal Disease

“…Our findings suggest that, in some instances, factors leading to ESRD may exist in the allograft before donation, as may be the case with genetically determined kidney disease. By extension, our findings also suggest that asymptomatic (and subtle), early-stage lesions may exist in the allograft before donation, as has been found at implantation biopsy (29)(30)(31)(32)(33)(34)(35), and that these lesions might be clinically relevant.…”

Association of donor hypertension and recipient renal function in living donor kidney transplantation: A single‐center retrospective study

“…As in previous studies, histologic findings from T0 biopsies did not predict recipient renal function . However, in combination, the cited studies only included 17 hypertensive donors.…”

HbA1c and Aortic Calcification Index as Noninvasive Predictors of Pre-Existing Histopathological Damages in Living Donor Kidney Transplantation

“…Aortic stiffness of living donors may also contribute to the recipient outcome beyond other parameters [ 41 ]. Another report also demonstrated that allografts from donors with vascular calcification had a high percentage of vascular fibrous intimal thickening and arteriolar hyaline thickening in the six-month surveillance biopsy [ 42 ]. The present study revealed that a higher ACI was associated with higher ci, ct, and ah scores.…”