The presence of glomerular sclerosis at time zero has a significant impact on function after cadaveric renal transplantation

Transplantation. 2003 Feb 15;75(3):344-6. doi: 10.1097/01.TP.0000044361.74625.E7.

Abstract

Introduction: The aim was to determine the impact of donor glomerulosclerosis on allograft outcome.

Methods: The percentage of glomerular sclerosis (%GS) was calculated in protocol biopsies taken at engraftment. Clinical variables were obtained from the Welsh Transplantation Research Group (WTRG) database.

Results: Of 210 allografts, 129 showed %GS=0, but 81 kidneys showed %GS between 1 and 60. Patients with %GS=0 had the highest glomerular filtration rate (GFR) at 1 year (62.0 mL/min) and the slowest deterioration of function (-3.8 mL/min per year). Patients with %GS greater than 20 had the lowest GFR at 1 year (36.0 mL/min) and the steepest rate of deterioration (-9.0 mL/min per year). The %GS of 10 alone can reduce GFR at 4 years by 8 mL/min, a similar reduction to a single rejection episode or an increase in donor age of 30 years. Actuarial 5-year graft survival for %GS=0 was 80%, and for %GS greater than 20 was 35% ( P=0.04).

Conclusion: The findings indicate that a biopsy taken at procurement will provide information for the most appropriate allocation of a kidney.

MeSH terms

  • Biopsy
  • Glomerulosclerosis, Focal Segmental / epidemiology
  • Glomerulosclerosis, Focal Segmental / pathology*
  • Glomerulosclerosis, Focal Segmental / surgery*
  • Graft Survival*
  • Humans
  • Kidney Transplantation*
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Tissue and Organ Procurement / standards*
  • Transplantation, Homologous