Vasa recta hyalinosis reflects severe arteriolopathy in renal allografts
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We examined the clinicopathologic significance of hyalinosis in the vasa recta in the medulla of allograft kidney biopsies.
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.
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).
VRH in renal allografts reflects severe arteriolopathy of the cortex. VRH in the late-phase biopsy may be a prognostic factor for graft survival.
KeywordsKidney transplantation Vasa recta hyalinosis Aah score Arteriolopathy
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.
Compliance with ethical standards
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).
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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