HbA1c and Aortic Calcification Index as Noninvasive Predictors of Pre-Existing Histopathological Damages in Living Donor Kidney Transplantation.

Kosuke Tanaka,Masayuki Kashima,Kenji Okumura,Yuji Hidaka,Chiaki Kawabata,Akari Kaba,Sho Nishida,Kohei Kinoshita,Shigeyoshi Yamanaga,Satoshi Hamanoue,Asami Takeda,Hiroshi Yokomizo,Akira Miyata,Mariko Toyoda,Toshinori Ishizuka

doi:10.3390/jcm9103266

Abstract

We previously reported that allografts from living donors may have pre-existing histopathological damages, defined as the combination of interstitial fibrosis (ci), tubular atrophy (ct), and arteriolar hyalinosis (ah) scores of ≧1, according to the Banff classification. We examined preoperative characteristics to identify whether the degree of these damages was related to metabolic syndrome-related factors of donors. We conducted a single-center cross-sectional analysis including 183 living kidney donors. Donors were divided into two groups: chronic change (ci + ct ≧ 1 ∩ ah ≧ 1, n = 27) and control (n = 156). Preoperative characteristics, including age, sex, blood pressure, hemoglobin A1c (HbA1c), aortic calcification index (ACI), and psoas muscle index (PMI), were analyzed. Comparing the groups, the baseline estimated glomerular filtration rate was not significantly different; however, we observed a significant difference for ACI (p = 0.009). HbA1c (p = 0.016) and ACI (p = 0.006) were independent risk factors to predict pre-existing histopathological damages, whereas PMI was not. HbA1c correlated with ct scores (p = 0.035), and ACI correlated with ci (p = 0.005), ct (p = 0.021), and ah (p = 0.017). HbA1c and ACI may serve as preoperative markers for identifying pre-existing damages on the kidneys of living donors.

Highlights

Renal transplantation is the best option for patients with end-stage renal disease (ESRD) [1]
This finding of chronic change (CC), defined by the combination of interstitial fibrosis, tubular atrophy, and arteriolar hyalinosis scores according to the Banff classification [8], is strongly associated with suboptimal recovery of the renal function in living donors 1 year after donation [7]
Positive ci and ct scores correspond to the interstitial fibrosis/tubular atrophy (IF/TA), which is a final pathway and prognostic factor of chronic kidney damages [9,10]

Summary

Introduction

Renal transplantation is the best option for patients with end-stage renal disease (ESRD) [1]. We have recently reported that healthy living donors may have pre-existing histopathological damages at baseline biopsy (1 h after the reperfusion) [7] This finding of chronic change (CC), defined by the combination of interstitial fibrosis (ci), tubular atrophy (ct), and arteriolar hyalinosis (ah) scores according to the Banff classification [8] (ci + ct 1 ∩ ah 1), is strongly associated with suboptimal recovery of the renal function in living donors 1 year after donation [7]. This combination represents the extent of renal chronic deterioration. The impact of the chronicity score was independent of the actual age [7]

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Methods

Conclusion