Donor kidney vasculopathy: impact on outcome in kidney transplantation.

A vasculopathy score (VP score) was designed in order to evaluate donor-related arteriosclerotic changes in kidney grafts. The four histopathological parameters that are semiquantitatively graded are glomerulosclerosis, stenosis and intimal hyperplasia of artery, and arteriolar hyalinization. The score of each parameter is weighted according to relative importance, and summed into a single parameter, the VP score. In order to evaluate the predictivity of the VP score on renal graft function, we applied this method to the first biopsy taken within 1 month after cadaveric kidney transplantation in 75 consecutive patients. The VP score was correlated to the following clinical data: graft survival at 3 months, 1 year, and 2 years after transplantation, graft function as reflected by need for hemodialysis within 1 week and 1 month, and serum creatinine level at 1 week, 1 year, and 2 years after transplantation. There was a significant correlation between VP score and donor age. In a particular case, however, age per se is not a good predictor of vascular status. Secondly, there was a significant correlation between short-term (3 months) graft survival and VP score, but none between 1 or 2 years graft survival and VP score. When two groups of patients with high and low VP scores, respectively, were compared, there were significant differences between graft function at 1 week and 1 year and graft survival at 3 months. Thus, our results show that the VP score is useful to predict short-term graft survival and graft function.