Abstract
Background and aim: Morphological regressive changes in zero-time biopsy may influence the graft function in post-transplant period. Methods: In a retrospective study of 42 ideal deceased kidney donors for pediatric transplantation, we semiquantitavely (0-3+) evaluated morphological regressive changes of the vessels, tubuli, interstitium, and the percentage of sclerotized glomeruli by light microscopy in a wedge zero-time biopsy.Results: Regressive changes of the glomerular hilar arteries were twice more frequent in men than in women.
Their progressed regression (3+) was present only in 2 men, but never in women. The larger arteries were normal in 3/4 of the donors, in remaining 1/4 the pathology was distributed equally between men and women.
A progressed stenosing arterial lesion was exceptional and was found in one man only. The advanced tubular atrophy and interstitial sclerosis were never found and their mild degree was discovered in 17 (40 %) donors, and was equally distributed between genders.
There were no sclerotized glomeruli in more than half donors (58 %). In the all group of 42 donors, a proportion of sclerotized glomeruli was 2.9+- 3.5 % (median 1.4).
The glomerular sclerosis directly correlated with age and was more frequent in men. In 42 renal grafted children from these donors, 21 boys, aged 3-18, we evaluated relations between these regressive changes and glomerular filtration rate (eGFR) at a) discharge from the hospital after surgery, b) 6 month after transplantation, c) one year, and d) at the end of follow-up (mean 2.5 y).In all time-intervals, eGFR was higher in grafts without arteriolar insudate (P<0.05, half year after transplantation), in grafts with intact larger arteries, and in grafts without tubulointerstitial regression six month after surgery and at the end of follow-up (P<0.05 and P<0.001, respectively).
The eGFR was also higher in patients receiving grafts without sclerotized glomeruli, but the difference did not reach statistical significance.Conclusion: The tubulointerstitial regressive changes present in zero-time biopsy were associated with lower graft function in the post-transplant period.