Abstract: SA-PO462

Peritubular Capillary Loss in the First Month after Kidney Transplantation Is More Pronounced in Patients with Rejection Compared to Delayed Graft Function

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Keijbeck, Anke, MUMC, Maastricht, Netherlands
  • Steegh, Floortje, MUMC, Maastricht, Netherlands
  • Gelens, Marielle, MUMC, Maastricht, Netherlands
  • Christiaans, Maarten H.L., MUMC, Maastricht, Netherlands
  • Peutz-Kootstra, Carine, MUMC, Maastricht, Netherlands
Background

Loss of peritubular capillaries (PTC) in patients with chronic transplant dysfunction is associated with worse outcome. We have shown previously that PTC loss occurs in the first three months after transplantation and precedes renal function decline (Steegh et al. JASN 2011). PTC density in the first weeks after transplantation has not yet been studied.

Methods

A cohort of 205 patients, who had a kidney transplantation between August 2003 and December 2009 at the Maastricht University Medical Centre and of whom representative protocol biopsies were taken at transplantation, and 3 and 12 months posttransplant, was analysed. In 102 of these patients an indication biopsy was taken in the first month after transplantation because of delayed graft function (DGF) or rise of creatinine. PTC numbers were studied as described earlier (Steegh et al. JASN 2011).

Results

Recipients who underwent an indication biopsy more often received a DCD graft. Consequently the ischemia times were higher than in the recipients who did not have an indication biopsy. Furthermore, patients with an indication biopsy developed more IF/TA 1 year after transplantation (p=0.04). In patients with indication biopsies, a significant loss of PTC density occurs already in the first month after transplantation (Figure 1 panel A) (p<0.01). This PTC loss is more pronounced in patients suffering from rejection than patients with DGF (Figure 1 panel B). However, in the rejection group there is a stabilisation of the PTC loss between 1 and three months, while in the DGF group there is further loss of PTCs (p<0.01).

Conclusion

We found that PTC loss occurs in the first weeks after transplantation. The pattern of PTC loss in the first 3 months after transplantation differs between patients with rejection and DGF. Prevention of microvascular damage during and early after transplantation may be crucial to prevent chronic transplant dysfunction.