Chronic renal homograft function: correlation with histology and lymphocyte antigen matching

Abstract

Renal function was studied in twenty-nine of thirty-four surviving renal allograft recipients from an initial group of sixty-four patients two years after transplantation. Mean clearances of inulin and PAH were, respectively, greater than and equal to half the donors’ initial predicted clearances. Minimum urine osmolality during water diuresis was greater, and maximum urine osmolality during hydropenia was less than normal, an effect attributable partly to enhanced solute load in a single transplanted kidney.

Patients with compatible donor-recipient lymphocyte antigens demonstrated statistically better function than those with one or more incompatibilities, although there was a definite degree of overlap between the two groups. In contrast, little correlation could be demonstrated between the cumulative histopathology and renal clearances.

Renal function in patients with compatible donors was statistically greater than half the donors’ initial predicted function. Serial increase in renal clearances was documented in one patient with a compatible donor. Serial decreases were demonstrated in two patients with incompatible donors. These findings suggest that hypertrophy of the denervated, transplanted kidney occurs when immune reaction is minimal.

Fig. 1

Relationship between effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) in twenty-nine renal allograft recipients.

Fig. 2

Relationship between glomerular filtration rate and maximum urine osmolality following fourteen hours total fast in twenty-seven renal allograft recipients and two renal isograft recipients.

Fig. 3

LD 36. Fibrous thickening of the intima of an interlobular artery. The lumen of the vessel is greatly narrowed. There is also generalized interstitial fibrosis, and tubular atrophy. Elastic stain, original magnification × 150.

Fig. 4

LD 51. Hyalinization of the walls of arterioles. Deposits of homogenous, periodic acid-Schiff–positive material are present in the walls of the afferent (broad arrow) and efferent (slender arrow) arterioles. There is also some mesangial and capillary basement membrane thickening in the adjacent glomerulus. Periodic acid-Schiff reagent original magnification × 500.

Fig. 5

LD 45. Thickening of glomerular capillary basement membranes. Two glomeruli show periodic acid-Schiff–positive thickening of their tuft capillary basement membranes. There is also tubular atropy, interstitial fibrosis and cellular infiltration of the interstitium. Periodic acid-Schiff stain, original magnification × 300.

Fig. 6

LD 48. Superficial subcapsular interstitial fibrosis. The renal tissue immediately beneath the capsule (cap) is scarred; the deeper part of the kidney is relatively normal. In the scarred zone there is also cellular infiltration, tubular atrophy and glomerular damage. Hematoxylin and eosin stain, original magnification × 70.

Fig. 7

Relationship between cumulative histopathology and effective renal plasma flow (left), and cumulative histopathology and glomerular filtration rate (right) in twenty-nine renal allograft recipients.

Fig. 8

Comparison of glomerular filtration rate (left), and effective renal plasma flow (right), in thirteen patients with compatible and sixteen patients with incompatible donor-recipient lymphocyte-antigen matches. The solid line in each group of values represents the mean.