Abstract: PUB349
Renal Allograft Cortical Necrosis: A Comprehensive Clinicopathologic Study
Session Information
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Feng, Frances, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Truong, Luan D., Houston Methodist Hospital, Houston, Texas, United States
Group or Team Name
- Houston Methodist Hospital.
Background
Renal graft cortical necrosis (GCN) is rare but carries significant clinical implications, including the potential for graft loss. The available literature on GCN is limited, and further studies are needed to enhance our understanding and improve management of this clinically important condition in renal transplantation.
Methods
Our retrospective study analyzed all biopsy-proven cases of GCN between 2015 and 2022. We examined the original specimens and subsequent follow-up biopsies or nephrectomies, reviewed patient clinical information, laboratory results, and tracked graft outcomes. By correlating the clinical and pathological findings, we identified potential factors that may contribute to the development of GCN.
Results
The overall incidence of GCN was 0.57%. Out of 3,855 biopsies, 18 from 18 individual patients showed cortical necrosis. Among these patients, 10 (56%) experienced graft failure (Group 1, G1), while 8 (44%) showed improvement or recovery of allograft function (Group 2, G2). Follow-up core biopsies were performed in 4 patients in G1, 3 of which were conducted within 2 weeks to 2 months after transplantation. Four patients underwent nephrectomy. There was no gender predilection, and the average patient age was 53.4 years.
In this study, over 70% of the initial biopsies were performed within the first month due to delayed graft function. Thrombosis of arteries and/or glomerular capillary lumens was observed in 90% of patients in G1, compared to 50% in G2. All 9 patients with thrombosis in G1 developed severe perioperative or immediate postoperative complications. In comparison, 50% of patients with thrombosis in G2 developed complications. Notably, 60% of patients in G1 received kidneys from living donors, compared with 25% in G2. In our study, only two patients were found to have developed rejection.
Conclusion
Firstly, the extent of cortical necrosis is the most important factor determining the outcome of the graft. Secondly, majority cortical necrosis, especially diffuse cortical necrosis, are associated with arterial thrombosis, Thirdly, the perioperative and postoperative complications are the major reasons causing cortical necrosis. Fourth, the underline baseline diseases are the additional factor which may cause or accentuate the extent of necrosis. Fifth, the resource of donor organ might be a potential factor for the cortical necrosis formation.