Individual Histologic Lesions and Composite Scores in Implant Biopsies Affect Short-Term and Long-Term Kidney Allograft Function.

OBJECTIVES: Our aim was to evaluate which histologic lesions in a donor kidney were associated with graft function up to 5 years and with its dynamics. MATERIALS AND METHODS: We retrospectively investigated the association between acute and chronic individual histologic lesions and composite scores in preimplant and postreperfusion biopsies from deceased-donor (n = 101) and living-donor (n = 29) kidneys with initial graft function and function at discharge, at 6 months, and at 5 years and slopes of estimated glomerular filtration rate from discharge to 6 months and from 6 months to 5 years. RESULTS: A high frequency of chronic and acute histologic lesions in donor kidneys is characteristic of our population of donors with high cardiovascular risk. Glomerulitis in preimplant biopsies predicted delayed graft function. Arteriolar hyalinosis predicted impaired initial graft function. Arteriolar hyalinosis and arteriosclerosis both predicted lower estimated glomerular filtration rate at discharge and ≥ 25% drop in function after 6 months. Glomerulosclerosis affected the estimated glomerular filtration rate at discharge and at 6 months; percentage of changed glomeruli predicted lower function at discharge and at 5 years. Glomerular thrombi in preimplant and postreperfusion biopsies predicted negative slope in estimated glomerular filtration rate from discharge to 6 months and a ≥ 25% drop in function after 6 months, respectively. Fibrinoid necrosis in glomeruli in preimplant biopsies predicted decline in function of ≥ 5 mL/min/1.73m² every year after 6 months. Chronic and total preimplant and posttransplant Banff scores predicted lower estimated glomerular filtration rate at discharge and at 6 months, with ≥ 25% drop in function after 6 months. CONCLUSIONS: Intraoperative biopsies are important in identifying patients at risk for worse graft function, especially concerning absence of gain of function early after transplant and loss of function late after transplant.

High urinary interleukin-2 in late post-transplant period portends a risk of decline in kidney allograft function: a preliminary study.

BACKGROUND: Predictive factors for the rate of decline in kidney allograft function beyond the first post-transplant year have not been thoroughly studied. We aimed to determine whether a single measurement of serum and urinary interleukin 2, interleukin 8 and interleukin 10 at 1-15 years after kidney transplantation could predict a decline in estimated glomerular filtration rate (eGFR) over a 2-year period. RESULTS: Greater serum concentrations of interleukin 8 and interleukin 10 in 30 recipients of kidney allograft at enrollment were associated with lower eGFR after 1 year (beta = - 0.616, p = 0.002 and beta = - 0.393, p = 0.035, respectively), whereas serum concentrations of interleukin 8 also demonstrated significant association with eGFR after 2 years of follow-up (beta = - 0.594, p = 0.003). Higher urinary interleukin 2 concentrations were associated with lower eGFR at baseline (rho = - 0.368, p = 0.049) and after the first (beta = - 0.481, p = 0.008) and the second year (beta = - 0.502, p = 0.006) of follow-up. Higher urinary interleukin 2 concentrations predicted certain decline in eGFR of ≥ 25% from baseline after 1 year of follow-up in logistic regression: odds ratio = 2.94, confidence interval 1.06-8.18, p = 0.038. When combined with time after transplantation, urinary interleukin 2 demonstrated good accuracy in predicting rapid decline in eGFR by > -5 mL/min/1.73 m2/year (area under the receiver-operator characteristic curve: 0.855, confidence interval 0.687-1.000, and p = 0.008). CONCLUSIONS: Our findings suggest that urinary interleukin 2 in the late period after kidney transplantation has promise in identifying patients who are at risk for progressive loss of graft function in a short-time perspective and need closer monitoring.

Peritransplant Soluble CD30 as a Risk Factor for Slow Kidney Allograft Function, Early Acute Rejection, Worse Long-Term Allograft Function, and Patients' Survival.

BACKGROUND: We aimed to determine whether serum soluble CD30 (sCD30) could identify recipients at high risk for unfavorable early and late kidney transplant outcomes. METHODS: Serum sCD30 was measured on the day of kidney transplantation and on the 4th day posttransplant. We assessed the value of these measurements in predicting delayed graft function, slow graft function (SGF), acute rejection (AR), pyelonephritis, decline of allograft function after 6 months, and graft and patient survival during 5 years of follow-up in 45 recipients. RESULTS: We found the association between low pretransplant serum levels of sCD30 and SGF. The absence of significant decrease of sCD30 on the 4th day posttransplant was characteristic for SGF, early AR (the 8th day-6 months), late AR (>6 months), and early pyelonephritis (the 8th day-2 months). Lower pretransplant and posttransplant sCD30 predicted worse allograft function at 6 months and 2 years, respectively. Higher pretransplant sCD30 was associated with higher frequency of early AR, and worse patients' survival, but only in the recipients of deceased-donor graft. Pretransplant sCD30 also allowed to differentiate patients with early pyelonephritis and early AR. CONCLUSIONS: Peritransplant sCD30 is useful in identifying patients at risk for unfavorable early and late transplant outcomes.