Histopathological signs and their relationships with survival in chronic allograft nephropathy

Aim: To investigate possible factors contributing to chronic allograft dysfunction (CAD), efficacy of histopathological evaluation in recipients with chronic allograft nephropathy (CAN), and determinative role of histopathological signs in graft survival. Methods: Data of the recipients who underwent renal transplantation (n=270) 10 years in our department were evaluated. The recipients were evaluated in 3 groups as normal allograft function (NAF) group (n=154) and CAD (n=64) and CAN (n=52) groups. Results: Regarding the allograft survival, the NAF group had the best allograft survival. The frequency of hepatitis C virus (HCV) positivity was significantly lower in the NAF group. Although not significant, the frequency of HCV differed between the CAN patients with and without glomerulopathy (34% and 23.5%, respectively). According to the 3-year allograft survival, graft loss was observed to be earlier in the patients with transplant glomerulopathy, without a significant difference. The frequency of proteinuria was higher in the CAD and CAN groups than in the NAF group and proteinuria was appeared firstly in the CAN group and then in the CAD and NAF groups. Fibrointimal thickening was present in 17 patients in the CAN group and the graft survival was observed to decrease with an increase in the fibrointimal thickening. In the CAD group, 30 patients had mild fibrosis and 20 had moderate/severe fibrosis. Tubulointerstitial fibrosis was more severe in the patients who received cyclosporine A. Conclusions: CAN after renal transplantation is frequently encountered and the risk of developing CAN increases in the long term after transplantation.