Nephrol Dial Transplant (1999) 14: 2445-2454
© 1999 European Renal Association-European Dialysis and Transplant Association
Living donor kidney transplants: a biopsy study 1 year after transplantation, compared with baseline changes and correlation to kidney function at 1 and 3 years
1 Institute of Pathology, 2 Department of Medicine, 3 Department of Surgery and 4 Department of Clinical Chemistry, The National Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
Correspondence and offprint requests to: Dr S. Sund, Institute of Pathology, The National Hospital, Rikshospitalet, N-0027 Oslo, Norway.
Introduction. Chronic changes in biopsies from long-term stable kidney allografts have been reported to correlate with graft prognosis. Morphological changes in baseline (`zero-hour') biopsies have been described as well, but their importance for long-term prognosis have been less clear. The aim of the present study was to evaluate biopsy changes from baseline to 1 year after transplantation in patients receiving kidneys from living donors, and to assess the possible prognostic implications of these findings.
Methods. Light microscopical changes in 18 gauge full-core biopsies were scored semi-quantitatively in 33 patients 1 year after transplantation, and compared to baseline changes previously reported [1]. All cases were also examined with transmission electron microscopy. The semi-quantitative data from baseline and at 1 year were correlated with kidney function 1 and 3 years after transplantation. The reproducibility of baseline findings regarding arteriosclerosis and arteriolar hyalinosis was tested by comparison with biopsies 1 week after transplantation (n=43).
Results. We found a significant increase in mesangial glomerular sclerosis (P<0.001), interstitial fibrosis/tubular atrophy (if/ta) (P=0.002), and mononuclear cell interstitial infiltration (P=0.003) after 1 year, compared to baseline changes. There was an increase of arteriosclerosis (P=0.028) and arteriolar hyalinosis (P=0.006) when compared to biopsies taken 1 week after transplantation, but not when compared to the `zero-hour' findings. Electron microscopy revealed one case of recurrent immune-complex glomerulonephritis and another case of recurrent light chain deposition kidney disease. Comparing 1-week vascular findings with baseline gave a low level of reproducibility, probably due to sampling error. Baseline biopsy findings could not predict long-term kidney function. In the 1-year biopsy, if/ta was significantly correlated with serum creatinine (P=0.007) and glomerular filtration rate (GFR) (P<0.001) at 1 year, with serum creatinine at 3 years (P=0.011), and with the first-year cumulative dose of methylprednisolone (P=0.004). Serum creatinine at 1 year, however, was found to be the most accurate predictor of 3-year kidney function (P<0.001). Donor age was correlated to kidney function at 3 years (P=0.013) but not at 1 year after transplantation.
Conclusion. Morphological changes in baseline biopsies of living donor kidneys tend to become more pronounced in well-functioning allografts during the first year after transplantation. In the 1 year biopsy, if/ta seems to be the most reliable variate for grading of chronic changes. However, 1-year serum creatinine predicted long-term kidney function more precisely than did the biopsy scores. Based on the results of the present study, a protocol 1-year biopsy does not seem warranted in the management of the graft recipient with a stable kidney function.
Keywords: kidney transplant biopsy; baseline; prognosis; transplant outcome; reproducibility
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