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| Vascular Changes in Series Biopsies of Renal Transplant Allograft |
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| Department of Urology, Hyogo Prefectural Nishinomiya Hospital |
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| Department of Specific Organ Regulation (Urology), Osaka University Graduate School of Medicine |
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Shiro Takahara, Koji Yazawa, Toshiyuki Tanaka
Toru Hanafusa, Akihiko Okuyama |
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Introduction:Chronic allograft dysfunction is multifactorial, and histology of long-term renal allograft shows variable findings. Serial biopsies after transplantation, so-called protocol biopsies, have the potential to elucidate sequential changes; however, evaluation of these specimens is time-consuming, and series are small because patients are reluctant to consent to repeated biopsies. For this reason, we decided to study the histopathology of one-point biopsy specimens performed on long-surviving renal allografts with stable function, and defined these biopsies as "non-episode" biopsies. Among the several diseases seen in non-episode biopsies, arteriolopathy such as drug-induced nephropathy, is one of the frequent diseases. However, it is unrelated to the dosage and the concentration of cyclosporine or tacrolimus. Consequently, we evaluated the clinicopathologic findings of arteriolopathy in this study in order to clarify whether cyclosporine (CsA) or tacrolimus (FK506) is responsible for these findings.
Methods:Patients who underwent a non-episode biopsy had a serum creatinine concentration less than 2.0 mg/dl, urinary protein of less than 500 mg/day, and a stable clinical course. Totally, 90 such biopsies were performed. Mean follow-up period after biopsy was 29 ±16 months. We evaluated the histopathologic findings and clinical outcome on each finding.
Results:Thirty-six of the 90 non-episode biopsy specimens showed findings of arteriolopathy. Chronic allograft nephropathy (CAN) is seen in 40 cases (31 cases are CAN-a, and 9 cases are CAN-b). Seventeen biopsy specimens were essentially normal. The frequency and the severity of arteriolopathy are not concerned with dosage and concentration of CsA or FK506. The arteriolopathy seen in non-episode biopsy was related to the time of the biopsy and the kidney age. Arteriolopathy in non-episode biopsy also had a relationship with hypertension, suggesting that it is important for graft survival to strictly control blood pressure. Conclusions. Non-episode biopsy has a predictive value of the long-term outcome of a renal allograft. biopsy showed the findings of arteriolopathy. Arteriolopathy in non-episode biopsy was related to time of biopsy, kidney age, hypertension and hyperlipidemia. Strict control of blood pressure and serum lipid level is important for graft survival.In conclusion, vascular changes seen in renal transplant allograft are important findings to predict long term graft prognosis.
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