Acta Chirurgica 36. (1997)

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Late graft function was monitored by clinical follow up and rebiopsies of viabile grafts during an average of 336 posttransplant days. There was no significant difference in graft survival between statistically evaluable groups (normal:78%, AS:70%). This means increased graft loss in AS-group compared to its early period (0% vs 30%). The graft loss is due to higher frequency of rejections (40%) and a need for rehemodialysis (15%) in arteriosclerosis graft. The worsening function was also reflected in high serum creatinin (253 [100^142] pM/L) levels of these recipients. Rare morphological forms of "zero-hour" biopsies (TIN, GN) were statistically non evaluable and carried either a bad (TIN) or a good (GN) long term graft survival. There was no significant difference in mismatch, age, sex, blood group, handling time, warm/cold ischaemia time and in clinical complications or therapy between the groups. Postoperative mortality rate was 4,7% (3/64), overall mortality was 17,2% (11/64) with 10,95% (7/64) extrarenal causes. Discussion "Zero-hour" biopsies of 65 donors have been performed since 1994. Only 38% of the cases showed no morphological abnormalities which motivated us to study and reevaluate the significance of "zero-hour" biopsies. Based on our findings we support the the literature that "zero-hour" biopsies do not predict late graft function and complications [1, 3, 4]. In addition we can conclude that there are potentially predictable morphological parameters of the graft at early stages. Renal allografts with arteriosclerosis had worse early function in their recipients reflected in higher serum creatinin levels compared to grafts with normal morphological findings. Acute tubular necrosis of renal allografts in our material statistically reduced graft viability, prolonged the delayed graft function time period. A similar value of tubular damage predicting graft loss was reported in renal allograft rebiopsies [2]. References 1. Curschellas E, Landmann J, Dürig M, Huser B, Kyo M, Basler V: Thiel G, Mihatsch MJ: Morphologic findings in "zero-hour" biopsies of renal transplants. Clin Nephrol 36(5):215, 1991 2. Mathew M, Bolton WK: Linear C3 deposits on the tubular basement membrane in renal allograft biopsies. Am J Kidney Dis 12(2): 121, 1988 3. Nemes В, Lázár N: Chronic rejection the final common path of renal allograft loss. Clinical pathological study (in Hungarian). Magy Seb 48:397, 1995 4. Perloff LJ, Goodloe S, Jenis EH, Light JA, Spees EK: Value of one-hour renal-allograft biopsy. Lancet Dec. 8, 1973 5. Soley K, Axelsen RA, Benediktsson H, Burdick JF, Cohen AH, Colvin RB, Croker BP, Droz D, Dunnill MS, Halloran PF: International standardization of criteria for the histological diagnosis of renal allograft rejection: the Banff working classification of kidney transplant pathology. Kidney Int 44(2):411, 1993

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