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

• Published in: Transplantation Vol. 75; no. 3; pp. 344 - 346
• Main Authors: ESCOFET, Xavier, OSMAN, Hisham, GRIFFITHS, David F. R, WOYDAG, Suzanna, JUREWICZ, W. Adam
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 15-02-2003
• Subjects: Biological and medical sciences; Biopsy; Glomerulosclerosis, Focal Segmental - epidemiology; Glomerulosclerosis, Focal Segmental - pathology; Glomerulosclerosis, Focal Segmental - surgery; Graft Survival; Humans; Kidney Transplantation; Medical sciences; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Proportional Hazards Models; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue and Organ Procurement - standards; Transplantation, Homologous; Kidney disease; Human; Glomerulonephritis; Urinary system disease; Renal function; Prognosis; Homograft; Transplantation; Kidney; Sclerosis; Rejection; Biopsy; Surgery; Cohort study; Predictive value; Cadaver; Survival curve
• ISSN: 0041-1337; 1534-6080
• DOI: 10.1097/01.TP.0000044361.74625.E7

The aim was to determine the impact of donor glomerulosclerosis on allograft outcome.
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.
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).
The findings indicate that a biopsy taken at procurement will provide information for the most appropriate allocation of a kidney.