Clinical Analysis of 10 Years Protocol Biopsy After Kidney Transplantation.

Purpose. The steady advances in immunosuppression have enabled control of early acute rejection, but long-term graft survival remains unchanged. Chronic histopathological changes influence graft survival rate. The aim of this study was to establish the relationship of risk factors interstitial fibrosis and tubular atrophy (IF/TA) on 10 years protocol biopsy.Methods. We assessed the histological findings obtained at 10 years protocol biopsy after living-donor kidney transplantation(KTx) of 62 patients who received kidney allografts between 1986 and 2003. Using the Banff'07 classification, we classified the patients into two groups, Group1 was less than IF/TA GradeI, Group2 was more than IF/TA GradeII. Risk factors for IF/TA were analyzed retrospectively.Results. The mean age of the recipient was 9.96±5.29 years old, 10 patients (16%) had a kidney from ABO incompatible donor. 62 patients were classified Group1 (n=36) and Group2 (n=26), there were no significant difference in original disease, recipient's age and sex, HLA mismatch, the relation of donor to recipient, CNI, CIT (Cold ischemic time) and except donor's age (38.8±6.97 years old (Group1) vs. 42.6±7.29 years old (Group2), p<0.05). But no significant difference, rate of ABO incompatible kidney transplantation (ABO-iKTx) had more Group1 than Group2 (22%(Group1) vs. 7.6%(Group2), NS). There were no significant difference evaluation of acute rejection(AR) within 1 years KTx between both Groups. We observed AR at 1 and 5 years protocol biopsy after KTx, Evaluation of AR were 22% and 8.5% of Group1, 24% and 28% of Group2. The ratio more than IF/TA GradeII were 20% in Group1 and 44% in Group2(p<0.05). eGFR post-transplantation was significantly difference between both groups (58.6±14.1(Group1) vs. 48.9±17.9(Group2)ml/min at 10 years, p<0.05).Conclusion. Chronic histopathological graft injury were established at 5 years KTx. IF/TA Grade of ABO-iKTx tend to be low, we should study that early modification of early immunosuppression may prevent the chronic histopathological graft injury and alter the long-term graft outcome.