Prevalence and risk factors for early chronic allograft nephropathy in a live related renal transplant program

Chronic allograft nephropathy (CAN) is a common cause of delayed allograftfailure throughout the world. Its prevalence and risk factors vary depending on a number offactors. There is little information on the prevalence and risk factors for early CAN in liverelated renal transplant patients. We aimed to determine the prevalence and the risk factors of early CAN in our setup.Patients and The study was conducted at Sindh Institute of Urology & Transplantation(SIUT), Karachi, from 2002 to 2005 on patients who had live related kidney transplantationand underwent at least one allograft biopsy within 18 months of transplantation. Thebiopsies were performed and prepared in accordance with established indications andguidelines. The Banff 97 classification and its updates were used to diagnose and categorizethe biopsy pathology. Patients were divided into two groups depending on the presence orabsence of CAN on biopsies. Following parameters were compared among the groups: age,sex, human leukocyte antigen (HLA) match, immunosuppression used, acute rejection (AR)episodes, urinary tract infections (UTIs), viral infections, cyclosporine levels, early and lategraft function monitored by serum creatinine. A total of 164 patients fulfilled the study inclusion criteria. The mean age of recipientsand donors was relatively young. The majority of the donors were siblings. The overallprevalence of CAN was 25.6% (42/164), between 3 and 18 months post transplantation.The median time to the appearance of CAN was 9 months post-transplant. The prevalenceof CAN increased as post-transplant duration increased. In 39 (92.8%) subjects, CAN wasdetected on the second or subsequent graft biopsy. Only 3 (7.2%) patients showed CAN onthe first graft biopsy. The majority of cases belonged to moderate degree or grade II CAN.The mean serum creatinine values were higher in the CAN group at the time of dischargeand all times post-transplantation. In conclusion, the results show that serum creatinine at the time of discharge isa useful predictor of later development of chronic changes in the allograft. Further studiesare needed to identify the risk factors for the early development of chronic changes in livingrelated renal transplant program.