engleski

Prognostic role of the kidney graft vasculopathy on the graft function five years post-transplant

INTRODUCTION: Histologic changes of kidney vessels are common finding on kidney graft biopsies at the time of kidney transplantation (Tx). There are two types of vascular changes: fibrointimal thickening of vessel wall (cv) affecting bigger vessels and arteriolar hyalinosis (ah) affecting afferent arterioles. We aimed to investigate prevalence, type and grade of graft vessel changes at time of Tx and their relation on graft function after Tx. METHODS: We retrospectively examined patients with kidney or simultaneous kidney and pancreas transplantation in University Hospital Merkur from 2008 until 2016. Eligible patients had to have protocol kidney biopsy at the time of implantation and 1 year after Tx. Kidney biopsies were analysed by light, immunoflorescence and electron microcopy. Graft vessel changes were scored in accordance with the Banff 97 classification and its updates. Progression of cv (∆cv) and ah (∆ah) score was calculated by subtracting implantation scores from scores 1 year post-transplant. In assesment of graft function we used eGFR based on MDRD formula and PCR (protein/creatinine ratio) in single urine sample. All statistical analyses were performed using “Statistica 17“ program and statistical significance was considered at p<0, 05. RESULTS: Our study included 141 patients. Demographic characteristics of recipients and donors are shown in Table 1. The mean initial cv and ah score was 0, 33 ± 0, 81 and 0, 86 ± 1, 07, respectively. 49, 9% of patients had initial ah score 0 and 75, 9% patients had initial cv score 0. Progression of ah and cv scores during first year after Tx was 0, 26 ± 1, 05 and 0, 03 ± 0, 92, respectively. In univariate analysis we found following parameters statistically significant negatively correlated with eGFR 5 years after Tx: donor age (R=-0, 56 ; p<0, 001), initial cv (R=-0, 34 ; p<0, 01), initial ah (R=-0, 29 ; p=0, 02), cv 1 year after Tx (R=-0, 42 ; p<0, 01), ah 1 year after Tx (R=-0, 3 ; p=0, 02), PCR 1 year after Tx (R=-0, 45 ; p<0, 001), PCR 2 years after Tx (R=-0, 59 ; p<0, 001). In a multivariate analysis only donor age (b=-0, 19 ; p<0, 05) and PCR 2 years after Tx (b=-0, 26, p<0, 001) remained negatively correlated with eGFR at 5 years post-transplant. Table 1. mean age (years) women men living (%) deceased (%) recipients 47, 8 ± 12, 2 37 104 / / donors 43, 4 ± 16, 2 59 82 15 (10, 6) 126 (89, 4) CONCLUSIONS: Prevalence of the graft vasculopathy at the moment of kidney transplantation is relatively high and increases with time after transplantation. In our study we did not prove predictive role of graft vasculopathy on graft function five years after transplantation. Donor age (graft age) at the moment of kidney transplantation and proteinuria at two years post- transplant are an important independent prognostic factors for graft function five years after kidney transplantation.

kidney transplantation ; graft vasculopathy ; prognosis

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