Denis Viglietti1, Imad Abboud, Gary Hill, Dewi Vernerey, Dominique Nochy, Corinne Antoine, Fabienne Fieux, Maureen Assayag, Jérôme Verine, François Gaudez, Alexandre Loupy, Denis Glotz, Carmen Lefaucheur. 1. 1 Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 2 Department of Pathology, Georges Pompidou European Hospital, Paris, France. 3 Biostatistics Unit, Paris Cardiovascular Research Centre, L'Université Paris Descartes, Paris, France. 4 Surgical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 5 Department of Pathology, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 6 Department of Urology, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 7 Department of Kidney Transplantation, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. † Deceased.
Abstract
BACKGROUND: Existing data suggest that increased interstitial fibrosis may occur abnormally in renal transplants from donations after uncontrolled circulatory death (uDCD). METHODS: To evaluate the factors that are associated with the progression of fibrosis and its functional impact on renal grafts, we compared 76 uDCD recipients with 86 recipients of kidney donations after brain death at 1-year after transplantation. Groups were matched for donor age, rank of transplantation, and absence of human leukocyte antigen sensitization. Histology was performed on sequential biopsies in uDCD recipients. Associations between variables were analyzed using linear mixed models and univariate analyses. RESULTS: In the uDCD group, increased fibrosis was detected 3 months after transplantation compared to before implantation. After 1 year, interstitial fibrosis and tubular atrophy score was significantly greater (1.5±0.7 vs. 1.0±0.9; P=0.003) and estimated glomerular filtration rate (49.5±17.4 vs. 60.6±19.1 mL/min/1.73 m2; P=0.0003) was significantly lower in the uDCD group than in the donations after brain death group. No flow duration and donor age were significantly associated with accelerated fibrosis. Interstitial fibrosis and tubular atrophy score, interstitial inflammation score, and estimated glomerular filtration rate were significantly worse in uDCD patients with no flow longer than 10 min. CONCLUSION: Donations after uncontrolled circulatory death grafts show more fibrosis after transplantation. No flow duration is associated with accelerated fibrosis and should be considered during uDCD graft allocation.
BACKGROUND: Existing data suggest that increased interstitial fibrosis may occur abnormally in renal transplants from donations after uncontrolled circulatory death (uDCD). METHODS: To evaluate the factors that are associated with the progression of fibrosis and its functional impact on renal grafts, we compared 76 uDCD recipients with 86 recipients of kidney donations after brain death at 1-year after transplantation. Groups were matched for donor age, rank of transplantation, and absence of human leukocyte antigen sensitization. Histology was performed on sequential biopsies in uDCD recipients. Associations between variables were analyzed using linear mixed models and univariate analyses. RESULTS: In the uDCD group, increased fibrosis was detected 3 months after transplantation compared to before implantation. After 1 year, interstitial fibrosis and tubular atrophy score was significantly greater (1.5±0.7 vs. 1.0±0.9; P=0.003) and estimated glomerular filtration rate (49.5±17.4 vs. 60.6±19.1 mL/min/1.73 m2; P=0.0003) was significantly lower in the uDCD group than in the donations after brain death group. No flow duration and donor age were significantly associated with accelerated fibrosis. Interstitial fibrosis and tubular atrophy score, interstitial inflammation score, and estimated glomerular filtration rate were significantly worse in uDCDpatients with no flow longer than 10 min. CONCLUSION: Donations after uncontrolled circulatory death grafts show more fibrosis after transplantation. No flow duration is associated with accelerated fibrosis and should be considered during uDCD graft allocation.
Authors: Hessel Peters-Sengers; Jaap J Homan van der Heide; Martin B A Heemskerk; Ineke J M Ten Berge; Fred C W Ultee; Mirza M Idu; Michiel G H Betjes; Arjan D van Zuilen; Maarten H L Christiaans; Luuk H Hilbrands; Aiko P J de Vries; Azam S Nurmohamed; Stefan P Berger; Frederike J Bemelman Journal: Transplantation Date: 2017-06 Impact factor: 4.939