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Vasa recta hyalinosis reflects severe arteriolopathy in renal allografts

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Abstract

Aim

We examined the clinicopathologic significance of hyalinosis in the vasa recta in the medulla of allograft kidney biopsies.

Method

We analyzed biopsy specimens from January 2010 to December 2015, obtained from both the cortex and medulla (including the vasa recta) ≥ 1 year after living-donor kidney transplantation. We excluded biopsy specimens from recipients who had undergone transplantation due to diabetic nephropathy or who had diabetes mellitus after transplantation. We evaluated hyaline arteriolopathy in the cortex using the aah score determined by the Banff 2007 classification.

Result

Among 381 biopsy specimens obtained from 248 transplant recipients ≥ 1 year after transplantation, 36 specimens obtained from 34 recipients showed vasa recta hyalinosis (VRH) in the medulla. Among these 36 specimens, 17 had a score of aah3, 16 had a score of aah2, and 3 had a score of aah1. The incidence of VRH was 1.9% at ≥ 1 to < 4 years, 7.1% at ≥ 4 to < 8 years, and 50.0% at ≥ 8 years. The aah scores and the proportion of hyalinosis in the arteriolar media among all muscular arterioles in the cortex were significantly higher in the VRH group at ≥ 8 years in the late-phase biopsy (P < 0.01). The graft survival was worse in the VRH group (P = 0.024), although there was no significant difference in the graft survival between the ≥ aah2 and < aah2 groups at ≥ 8 years in the late-phase biopsy (P = 0.159).

Conclusion

VRH in renal allografts reflects severe arteriolopathy of the cortex. VRH in the late-phase biopsy may be a prognostic factor for graft survival.

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Acknowledgements

We are grateful to Dr Takayuki Abe, Department of Preventive Medicine and Public Health, Biostatistics Unit at Clinical Translational Research Center, Keio University School of Medicine, for helpful comments about statistics analysis.

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Authors and Affiliations

  1. Department of Nephrology, Toho University Faculty of Medicine, Tokyo, 143-8541, Japan

    Hideyo Oguchi, Ken Sakai, Masaki Muramatsu, Yoshihiro Itabashi, Kazunobu Shinoda, Yoji Hyodo, Yusuke Takahashi, Yuki Kawaguchi, Hiroka Onishi, Yuko Hamasaki & Seiichiro Shishido

  2. Yamaguchi’s Pathology Laboratory, Chiba, 270-2231, Japan

    Yutaka Yamaguchi

  3. Department of Pathology, Toho University Faculty of Medicine, Tokyo, 143-8541, Japan

    Tetuo Mikami

  4. Department of Surgical Pathology, Toho University Faculty of Medicine, Tokyo, 143-8541, Japan

    Tetsuo Nemoto & Kazutoshi Shibuya

  5. Department of Nephrology, Sakura Medical Center, Toho University, Chiba, 285-8741, Japan

    Yasushi Ohashi & Takeshi Kawamura

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  1. Hideyo Oguchi
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Corresponding author

Correspondence to Hideyo Oguchi.

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Conflict of interest

Kazutoshi Shibuya received research grants from Pfizer Inc. Dainippon-Sumitomo Pharma and Astellas Pharma Inc, and also received payments for lecture from Dainippon-Sumitomo Pharma.

Human and animal rights

Our study was approved by Toho University Omori Medical Center Ethics Committee (approval number 27-260).

Informed consent

After approval of the Ethics Committee, the contents of this retrospective research and message to contact us if the patient cannot accept this research were posted on homepage of Toho University Omori Medical Center.

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Oguchi, H., Sakai, K., Yamaguchi, Y. et al. Vasa recta hyalinosis reflects severe arteriolopathy in renal allografts. Clin Exp Nephrol 23, 799–806 (2019). https://doi.org/10.1007/s10157-019-01709-6

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  • DOI: https://doi.org/10.1007/s10157-019-01709-6

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