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J Nephropathol. 2014;3(2): 69-79.
doi: 10.12860/jnp.2014.15
PMID: 24772400
PMCID: PMC3999587
Scopus ID: 84902132265
  Abstract View: 2638
  PDF Download: 1332

Original Article

Prevalence and risk factors for early chronic allograft nephropathy in a live related renal transplant program

Hamid Khan 1, Muhammed Mubarak 2*, Tahir Aziz 1, Ejaz Ahmed 1, Syed Fazal Akhter 1, Javed Kazi 2, Syed AA Naqvi 3, Syed AH Rizvi 3

1 Department of Nephrology, Sindh Institute of Urology and Transplantation (SIUT) Karachi, Pakistan
2 Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT) Karachi, Pakistan
3 Department of Urology, Sindh Institute of Urology and Transplantation (SIUT) Karachi, Pakistan
*Corresponding Author: Corresponding author: Prof. Muhammed Mubarak, Histopathology Department, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, Email: drmubaraksiut@yahoo.com

Abstract

Background:

Chronic allograft nephropathy (CAN) is a common cause of delayed allograft failure throughout the world. Its prevalence and risk factors vary depending on a number of factors. There is little information on the prevalence and risk factors for early CAN in live related renal transplant patients.

Objectives: We aimed to determine the prevalence and the risk factors of early CAN in our setup.

Patients and Methods: The study was conducted at Sindh Institute of Urology & Transplantation (SIUT), Karachi, from 2002 to 2005 on patients who had live related kidney transplantation and underwent at least one allograft biopsy within 18 months of transplantation. The biopsies were performed and prepared in accordance with established indications and guidelines. The Banff 97 classification and its updates were used to diagnose and categorize the biopsy pathology. Patients were divided into two groups depending on the presence or absence of CAN on biopsies. Following parameters were compared among the groups: age, sex, human leukocyte antigen (HLA) match, immunosuppression used, acute rejection (AR) episodes, urinary tract infections (UTIs), viral infections, cyclosporine levels, early and late graft function monitored by serum creatinine.

Results: A total of 164 patients fulfilled the study inclusion criteria. The mean age of recipients and donors was relatively young. The majority of the donors were siblings. The overall prevalence of CAN was 25.6% (42/164), between 3 and 18 months post transplantation. The median time to the appearance of CAN was 9 months post-transplant. The prevalence of CAN increased as post-transplant duration increased. In 39 (92.8%) subjects, CAN was detected on the second or subsequent graft biopsy. Only 3 (7.2%) patients showed CAN on the first graft biopsy. The majority of cases belonged to moderate degree or grade II CAN. The mean serum creatinine values were higher in the CAN group at the time of discharge and all times post-transplantation.

Conclusions: In conclusion, the results show that serum creatinine at the time of discharge is a useful predictor of later development of chronic changes in the allograft. Further studies are needed to identify the risk factors for the early development of chronic changes in living related renal transplant program.


Implication for health policy/practice/research/medical education:

Chronic allograft nephropathy (CAN) is a common cause of delayed allograft failure throughout the world. Its prevalence and risk factors vary depending on a number of factors. Traditionally, it was thought that, once the diagnosis of CAN has been made, it is difficult to alter the course of progression of the scarring process and the final outcome. However, more recently, with the availability of new immunosuppressants with antifibrotic properties, it appears that this process can be stopped and even reversed if diagnosed early. This study is an attempt to identify CAN at an early stage and to identify the risk factors underlying CAN in a live related renal transplant program. The study is an important contribution to the scanty literature in this area.

Please cite this paper as: Khan H, Mubarak M, Aziz T, Ahmed E, Akhter SF, Kazi J, et al. Prevalence and risk factors for early chronic allograft nephropathy in a live related renal transplant program. J Nephropathol. 2014; 3(2): 69-79. DOI: 10.12860/jnp.2014.15

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ePublished: 01 Apr 2014
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