Background: Donor shortage is a serious problem worldwide and it is now debated whether kidneys from marginal donors are suitable for renal transplantation. Recent studies have shown that the findings of preimplantation kidney biopsy are useful to evaluate vasculopathy in the donated kidney, and may predict transplant outcomes in deceased- donor kidney transplantation. However, few studies have focused on the pathological findings of preimplantation biopsy in living-donor kidney transplantation. Therefore, we investigated whether arteriosclerotic vasculopathy in living-donor kidneys at the time of transplantation predicts the recipient’s kidney function (allograft function) later in life. Methods: We retrospectively analyzed 75 consecutive adult living-donor kidney transplants performed at Kagawa University Hospital. Renal arteriosclerotic vasculopathy was defined according to the presence of fibrous intimal thickening in the interlobular artery. Results: Forty-one kidneys exhibited mild arteriosclerotic vasculopathy on preimplantation kidney biopsies. The decreases in estimated glomerular filtration rate after donation were similar in donors with or without renal arteriosclerotic vasculopathy. Pre-existing arteriosclerotic vasculopathy did not affect graft survival rate, patient survival rate or the incidence of complications. Recipients of kidneys with arteriosclerotic vasculopathy had lower allograft function at 1 and 3 years after transplantation than the recipients of arteriosclerosis-free kidneys with or without donor hypertension. In multivariate analysis, fibrous intimal thickening on preimplantation biopsy was predictive of reduced allograft function at 1 year after transplantation. Conclusions: The present study demonstrated that mild arteriosclerotic vasculopathy in the donated kidney is an important pathological factor that reflects future impaired function of renal allografts from marginal donors.

Laupacis A, Keown P, Pus N, Krueger H, Ferguson B, Wong C, Muirhead N: A study of the quality of life and cost-utility of renal transplantation. Kidney Int 1996;50:235–242.
Edwards EB, Bennett LE, Cecka JM: Effect of HLA matching on the relative risk of mortality for kidney recipients: a comparison of the mortality risk after transplant to the mortality risk of remaining on the waiting list. Transplantation 1997;64:1274–1277.
Mizutani K, Ono Y, Kinukawa T, Hattori R, Nishiyama N, Kamihila O, Ohshima S: Use of marginal organs from non-heart-beating cadaveric kidney donors. Transplantation 2001;72:1376–1380.
Tanabe K, Oshima T, Tokumoto T, Ishikawa N, Kanematsu A, Shinmura H, Koga S, Fuchinoue S, Takahashi K, Toma H: Long-term renal function in on-heart-beating donor kidney transplantation: a single-center experience. Transplantation 1998;66:1708–1713.
Matas AJ: Transplantation using marginal living donors. Am J Kidney Dis 2006;47:353–355.
Delmonico F: A report of the Amsterdam Forum on the Care of the Live Kidney Donor: data and medical guidelines. Transplantation 2005;79:S53–S66.
Issa N, Stephany B, Fatica R, Nurko S, Krishnamurthi V, Goldfarb DA, Braun WE, Dennis VW, Heeger PS, Poggio ED: Donor factors influencing graft outcomes in live donor kidney transplantation. Transplantation 2007;83:593–599.
Ito S, Nagasawa T, Abe M, Mori T: Strain vessel hypothesis: a viewpoint for linkage of albuminuria and cerebro-cardiovascular risk. Hypertens Res 2009;32:115–121.
Marin R, Gorostidi M, Fernandez-Vega F, Alvarez-Navascues R: Systemic and glomerular hypertension and progression of chronic renal disease: the dilemma of nephrosclerosis. Kidney Int 2005:S52–S56.
Hill GS: Hypertensive nephrosclerosis. Curr Opin Nephrol Hypertens 2008;17:266–270.
Woestenburg AT, Verpooten GA, Ysebaert DK, Van Marck EA, Verbeelen D, Bosmans JL: Fibrous intimal thickening at implantation adversely affects long-term kidney allograft function. Transplantation 2009;87:72–78.
Munivenkatappa RB, Schweitzer EJ, Papadimitriou JC, Drachenberg CB, Thom KA, Perencevich EN, Haririan A, Rasetto F, Cooper M, Campos L, Barth RN, Bartlett ST, Philosophe B: The Maryland aggregate pathology index: a deceased donor kidney biopsy scoring system for predicting graft failure. Am J Transplant 2008;8:2316–2324.
Yilmaz S, McLaughlin K, Paavonen T, Taskinen E, Monroy M, Aavik E, Vamvakopoulos J, Hayry P: Clinical predictors of renal allograft histopathology: a comparative study of single-lesion histology versus a composite, quantitative scoring system. Transplantation 2007;83:671–676.
Darmady EM, Offer J, Woodhouse MA: The parameters of the ageing kidney. J Pathol 1973;109:195–207.
Kasiske BL: Relationship between vascular disease and age-associated changes in the human kidney. Kidney Int 1987;31:1153–1159.
Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A: Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 2009;53:982–992.
Solez K, Colvin RB, Racusen LC, Haas M, Sis B, Mengel M, Halloran PF, Baldwin W, Banfi G, Collins AB, Cosio F, David DS, Drachenberg C, Einecke G, Fogo AB, Gibson IW, Glotz D, Iskandar SS, Kraus E, Lerut E, Mannon RB, Mihatsch M, Nankivell BJ, Nickeleit V, Papadimitriou JC, Randhawa P, Regele H, Renaudin K, Roberts I, Seron D, Smith RN, Valente M: Banff 07 classification of renal allograft pathology: updates and future directions. Am J Transplant 2008;8:753–760.
Timsit MO, Yuan X, Floerchinger B, Ge X, Tullius SG: Consequences of transplant quality on chronic allograft nephropathy. Kidney Int Suppl 2010;119:S54–S58.
Lopes JA, Moreso F, Riera L, Carrera M, Ibernon M, Fulladosa X, Grinyo JM, Seron D: Evaluation of pre-implantation kidney biopsies: comparison of Banff criteria to a morphometric approach. Kidney Int 2005;67:1595–1600.
Pokorna E, Vitko S, Chadimova M, Schuck O: Adverse effect of donor arteriolosclerosis on graft outcome after renal transplantation. Nephrol Dial Transplant 2000;15:705–710.
Kayler LK, Mohanka R, Basu A, Shapiro R, Randhawa PS: Correlation of histologic findings on preimplant biopsy with kidney graft survival. Transpl Int 2008;21:892–898.
Rule AD, Amer H, Cornell LD, Taler SJ, Cosio FG, Kremers WK, Textor SC, Stegall MD: The association between age and nephrosclerosis on renal biopsy among healthy adults. Ann Intern Med 2010;152:561–567.
Tracy RE, Berenson G, Wattigney W, Barrett TJ: The evolution of benign arterionephrosclerosis from age 6 to 70 years. Am J Pathol 1990;136:429–439.
Melk A, Schmidt BM, Braun H, Vongwiwatana A, Urmson J, Zhu LF, Rayner D, Halloran PF: Effects of donor age and cell senescence on kidney allograft survival. Am J Transplant 2009;9:114–123.
Hoy WE, Hughson MD, Bertram JF, Douglas-Denton R, Amann K: Nephron number, hypertension, renal disease, and renal failure. J Am Soc Nephrol 2005;16:2557–2564.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.