Risk Factors for Transplant Vasculopathy in Kidney Transplant

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IntroductionTransplant vasculopathy(Tv) is a confusing term that included endarteritis,atherosclerosis, and allograft arteriopathy. Kidney transplant is a model for the antibody-dependent and independent immune vascular injury. It is often more severe or “accelerated” than expected based on the age of the donor and could lead to graft loss.The aim of this study is to evaluated the presence of transplant vasculopathy in kidney transplant biopsies and risk factors associated.MethodsThis retrospective study included 239 allograft biopsies for cause in 112 kidney transplant recipient from 2015 to 2016. All biopsies, with and without transplant arteriopathy, donor, recipient and transplant proper variables were analyzed.Statistical AnalysisAll data are expressed as mean ± standard deviation or proportions, unless otherwise indicated. Considering the presence of vasculopathy as dependent variable we performed a univariate analysis with the others variables. Unpaired ‘t’ test was used for those normally distributed variables whereas the Fisher exact test was used for comparison of count variables. A a P-value ≤ 0.05 was considered statistically significant. All variables that had statistical significance were included in a multiple logistic regression model.ResultsTransplant vasculopathy was found in 55/112 patients (52.9%) Recipient age was 46 (18-75 ) years,sixty were men, 41% were sensitized and 10% were hypersensitized. Donor age was 42.98 (11-72) years, 58 males, 61(56%) were deceased donor and 11 met expanded criteria(10%). In 54.23% cerebrovascular/stroke was the cause of death among deceased donors (CVA-Death), 15% were hypertensive and two were diabetic. Mean Ischemic time was 19 ± 5 hours. In univariate analysis transplant vasculopathy was correlated with donor age : 60% positive in patient >45 years vs 35% in patients <35 years, donor males 59% vs 34 % ( p<0.03.). In cadaveric donors with vascular brain accident as death cause Transplant vasculopathy was found in 64.3% of biopsies vs only in 10% of donor traumatic brain death(p<0.004). As regards immunological factors: in biopsies consistent with microcirculation injury(IM) vascular injury was present in 62.3 %vs 34% in biopsies without inflammation (p< 0.0001).In multivariate analysis only microvascular injury results significative.ConclusionIn this study risk factors associated with develop of transplant vasculopathy in kidney allograft biopsies were: older and male donors, vascular brain accident as death cause and microcirculation injury in graft biopsies.

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