INTRODUCTION: Nephrosclerosis is often associated with pathological injury to kidneys resulting from chronic high blood pressure and/or aging, and may predict the progression of decline in renal function. We sought to evaluate pathological features of implant biopsies, such as arteriolosclerosis (AS), arteriolar hyalinosis (AH), microthrombi, and glomerulosclerosis (GS), and to correlate this pathology with renal function in living transplant donors.

METHODS: A retrospective review of 100 living donor renal transplants was conducted, from June 2012 to June 2015. All recipient biopsies were obtained intra-operatively, and evaluated for pathological abnormalities. The impact of the presence of arterial abnormalities on donor serum creatinine at five different time points was evaluated (pre-operative, and at 2, 26, 52, and 104 weeks post-donation). Arterial changes were defined as the presence of at least one of the following: AS, AH or microthrombi.

RESULTS: Donors' (N=100) mean age was 43 years (range 20-67), 66 were female and 80 were white. Of the recipient biopsies done intra-operatively, 55/100 reported abnormal pathology (31% GS, 17% AS, and 13% AH). Donors with age greater than 50 years were more likely to have arterial changes (OR 3.35; 95% CI [1.31-8.59]). In a multivariate model adjusting for race, gender, body mass index (BMI), and baseline kidney function, arterial hyalinosis was associated with age (OR 1.10; 95% CI [1.03-1.17]). However, age was not associated with neither AS, microthrombi or GS. Arterial changes were not significantly associated with race, BMI, or pre/post-operative serum creatinine values.

CONCLUSIONS: These results suggest that despite all donors meeting pre-operative criteria, older donors demonstrated more pathological arterial changes, especially AH. Of additional concern, the shear number of healthy donors who displayed pathological changes at the time of transplant suggests that the evaluation of donor candidates may not be entirely adequate. Further research into the long-term outcomes of donor populations, as well as the recovery of renal function in recipients, is underway.

CITATION INFORMATION: Tinney Jr F, Yessayan L, Abouljoud M, Patel A. Characterization of Vascular Lesions in Living Donor Renal Transplant Implant Biopsies. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress