1
|
Mella A, Calvetti R, Barreca A, Congiu G, Biancone L. Kidney transplants from elderly donors: what we have learned 20 years after the Crystal City consensus criteria meeting. J Nephrol 2024:10.1007/s40620-024-01888-w. [PMID: 38446386 DOI: 10.1007/s40620-024-01888-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/03/2024] [Indexed: 03/07/2024]
Abstract
Based on the current projection of the general population and the combined increase in end-stage kidney disease with age, the number of elderly donors and recipients is increasing, raising crucial questions about how to minimize the discard rate of organs from elderly donors and improve graft and patient outcomes. In 2002, extended criteria donors were the focus of a meeting in Crystal City (VA, USA), with a goal of maximizing the use of organs from deceased donors. Since then, extended criteria donors have progressively contributed to a large number of transplanted grafts worldwide, posing specific issues for allocation systems, recipient management, and therapeutic approaches. This review analyzes what we have learned in the last 20 years about extended criteria donor utilization, the promising innovations in immunosuppressive management, and the molecular pathways involved in the aging process, which constitute potential targets for novel therapies.
Collapse
Affiliation(s)
- Alberto Mella
- Renal Transplant Center" A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88, 10126, Turin, Italy
| | - Ruggero Calvetti
- Renal Transplant Center" A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88, 10126, Turin, Italy
| | - Antonella Barreca
- Division of Pathology, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Congiu
- Renal Transplant Center" A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88, 10126, Turin, Italy
| | - Luigi Biancone
- Renal Transplant Center" A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88, 10126, Turin, Italy.
| |
Collapse
|
2
|
Eccher A, Becker JU, Pagni F, Cazzaniga G, Rossi M, Gambaro G, L’Imperio V, Marletta S. The Puzzle of Preimplantation Kidney Biopsy Decision-Making Process: The Pathologist Perspective. Life (Basel) 2024; 14:254. [PMID: 38398762 PMCID: PMC10890315 DOI: 10.3390/life14020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Kidney transplantation is the best treatment for end-stage renal disease since it offers the greatest survival benefit compared to dialysis. The gap between the number of renal transplants performed and the number of patients awaiting renal transplants leads to a steadily increasing pressure on the scientific community. Kidney preimplantation biopsy is used as a component of the evaluation of organ quality before acceptance for transplantation. However, the reliability and predictive value of biopsy data are controversial. Most of the previously proposed predictive models were not associated with graft survival, but what has to be reaffirmed is that histologic examination of kidney tissue can provide an objective window on the state of the organ that cannot be deduced from clinical records and renal functional studies. The balance of evidence indicates that reliable decisions about donor suitability must be made based on the overall picture. This work discusses recent trends that can reduce diagnostic timing and variability among players in the decision-making process that lead to kidney transplants, from the pathologist's perspective.
Collapse
Affiliation(s)
- Albino Eccher
- Department of Medical and Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, 41100 Modena, Italy
| | - Jan Ulrich Becker
- Institute of Pathology, University Hospital of Cologne, 50923 Cologne, Germany;
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, 20126 Milano, Italy; (F.P.); (G.C.); (V.L.)
| | - Giorgio Cazzaniga
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, 20126 Milano, Italy; (F.P.); (G.C.); (V.L.)
| | - Mattia Rossi
- Division of Nephrology, Department of Medicine, University of Verona, 37129 Verona, Italy; (M.R.); (G.G.)
| | - Giovanni Gambaro
- Division of Nephrology, Department of Medicine, University of Verona, 37129 Verona, Italy; (M.R.); (G.G.)
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, 20126 Milano, Italy; (F.P.); (G.C.); (V.L.)
| | - Stefano Marletta
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37129 Verona, Italy;
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy
| |
Collapse
|
3
|
Yi Z, Xi C, Menon MC, Cravedi P, Tedla F, Soto A, Sun Z, Liu K, Zhang J, Wei C, Chen M, Wang W, Veremis B, Garcia-Barros M, Kumar A, Haakinson D, Brody R, Azeloglu EU, Gallon L, O'Connell P, Naesens M, Shapiro R, Colvin RB, Ward S, Salem F, Zhang W. A large-scale retrospective study enabled deep-learning based pathological assessment of frozen procurement kidney biopsies to predict graft loss and guide organ utilization. Kidney Int 2024; 105:281-292. [PMID: 37923131 PMCID: PMC10892475 DOI: 10.1016/j.kint.2023.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023]
Abstract
Lesion scores on procurement donor biopsies are commonly used to guide organ utilization for deceased-donor kidneys. However, frozen sections present challenges for histological scoring, leading to inter- and intra-observer variability and inappropriate discard. Therefore, we constructed deep-learning based models to recognize kidney tissue compartments in hematoxylin & eosin-stained sections from procurement needle biopsies performed nationwide in years 2011-2020. To do this, we extracted whole-slide abnormality features from 2431 kidneys and correlated with pathologists' scores and transplant outcomes. A Kidney Donor Quality Score (KDQS) was derived and used in combination with recipient demographic and peri-transplant characteristics to predict graft loss or assist organ utilization. The performance on wedge biopsies was additionally evaluated. Our model identified 96% and 91% of normal/sclerotic glomeruli respectively; 94% of arteries/arterial intimal fibrosis; 90% of tubules. Whole-slide features of Sclerotic Glomeruli (GS)%, Arterial Intimal Fibrosis (AIF)%, and Interstitial Space Abnormality (ISA)% demonstrated strong correlations with corresponding pathologists' scores of all 2431 kidneys, but had superior associations with post-transplant estimated glomerular filtration rates in 2033 and graft loss in 1560 kidneys. The combination of KDQS and other factors predicted one- and four-year graft loss in a discovery set of 520 kidneys and a validation set of 1040 kidneys. By using the composite KDQS of 398 discarded kidneys due to "biopsy findings", we suggest that if transplanted, 110 discarded kidneys could have had similar survival to that of other transplanted kidneys. Thus, our composite KDQS and survival prediction models may facilitate risk stratification and organ utilization while potentially reducing unnecessary organ discard.
Collapse
Affiliation(s)
- Zhengzi Yi
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York New York, USA
| | - Caixia Xi
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York New York, USA
| | - Madhav C Menon
- Nephrology Division, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Paolo Cravedi
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York New York, USA
| | - Fasika Tedla
- The Recanati/Miller Transplantation Institute (RMTI), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alan Soto
- Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zeguo Sun
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York New York, USA
| | - Keyu Liu
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York New York, USA
| | - Jason Zhang
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York New York, USA
| | - Chengguo Wei
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York New York, USA
| | - Man Chen
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York New York, USA
| | - Wenlin Wang
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York New York, USA
| | - Brandon Veremis
- Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Monica Garcia-Barros
- Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Abhishek Kumar
- Nephrology Division, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Danielle Haakinson
- Nephrology Division, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rachel Brody
- Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Evren U Azeloglu
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York New York, USA
| | - Lorenzo Gallon
- Northwestern Medicine Organ Transplantation Center, Northwestern University, Chicago, Illinois, USA
| | - Philip O'Connell
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Maarten Naesens
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Ron Shapiro
- The Recanati/Miller Transplantation Institute (RMTI), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert B Colvin
- Department of Pathology, Massachusetts General Hospital. Boston, Massachusetts, USA; Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen Ward
- Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Fadi Salem
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Weijia Zhang
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York New York, USA.
| |
Collapse
|
4
|
Wang M, Lv J, Zhao J, Wang H, Chen J, Wu J. Postreperfusion Renal Allograft Biopsy Predicts Outcome of Single-Kidney Transplantation: A 10-Year Observational Study in China. Kidney Int Rep 2024; 9:96-107. [PMID: 38312778 PMCID: PMC10831381 DOI: 10.1016/j.ekir.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/15/2023] [Accepted: 10/23/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Biopsy findings often lead to the discard of many donor kidneys although their clinical value is not fully understood. We investigated the predictive value of postreperfusion biopsy on long-term allograft outcome after single-kidney transplantation. Methods We retrospectively evaluated the significance of histologic findings, read by experienced renal pathologists, in 461 postreperfusion biopsy specimens collected from 2010 to 2017 after deceased donor renal transplant; and performed time-to-event analyses to determine the association between histology and hazard of death-censored graft failure. Recipients were followed-up with over a median time of 6.8 (range, 0.2-11.9) years. We assessed specimens using the Remuzzi score (scale of 0-12) and categorized them into low-score (≤3) and high-score (>3) groups. Kappa coefficients were calculated to assess agreement in procurement versus reperfusion biopsies. Results High Remuzzi score kidneys came from older donors with a higher incidence of hypertension, higher final creatinine, death from cerebrovascular disease, expanded criteria donor, and a higher kidney donor risk index (KDRI) (all P < 0.001). In adjusted analyses, Remuzzi score was independently associated with death-censored graft failure (hazard ratio [HR] 1.389 for each 1 score rise in Remuzzi score, 95% confidence interval 1.181-1.633, P < 0.001). Overall histologic agreement (procurement biopsy versus reperfusion biopsy) was kappa = 0.137. Conclusion Our findings suggest that postreperfusion biopsy is associated with long-time graft outcomes after transplant from a deceased donor. Agreement between procurement and reperfusion biopsy was found to be low. Prospective trials are necessary to optimize procurement biopsy practices.
Collapse
Affiliation(s)
- Meifang Wang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
- National Key Clinical Department of Kidney Diseases, Hangzhou, China
- Institute of Nephrology, Zhejiang University, Hangzhou, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Junhao Lv
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
- National Key Clinical Department of Kidney Diseases, Hangzhou, China
- Institute of Nephrology, Zhejiang University, Hangzhou, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Jie Zhao
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
- National Key Clinical Department of Kidney Diseases, Hangzhou, China
- Institute of Nephrology, Zhejiang University, Hangzhou, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Huiping Wang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
- National Key Clinical Department of Kidney Diseases, Hangzhou, China
- Institute of Nephrology, Zhejiang University, Hangzhou, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
- National Key Clinical Department of Kidney Diseases, Hangzhou, China
- Institute of Nephrology, Zhejiang University, Hangzhou, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Jianyong Wu
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
- National Key Clinical Department of Kidney Diseases, Hangzhou, China
- Institute of Nephrology, Zhejiang University, Hangzhou, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| |
Collapse
|
5
|
Zaza G, Cucchiari D, Becker JU, de Vries APJ, Eccher A, Florquin S, Kers J, Rabant M, Rossini M, Pengel L, Marson L, Furian L. European Society for Organ Transplantation (ESOT)-TLJ 3.0 Consensus on Histopathological Analysis of Pre-Implantation Donor Kidney Biopsy: Redefining the Role in the Process of Graft Assessment. Transpl Int 2023; 36:11410. [PMID: 37470063 PMCID: PMC10353313 DOI: 10.3389/ti.2023.11410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/31/2023] [Indexed: 07/21/2023]
Abstract
The ESOT TLJ 3.0. consensus conference brought together leading experts in transplantation to develop evidence-based guidance on the standardization and clinical utility of pre-implantation kidney biopsy in the assessment of grafts from Expanded Criteria Donors (ECD). Seven themes were selected and underwent in-depth analysis after formulation of PICO (patient/population, intervention, comparison, outcomes) questions. After literature search, the statements for each key question were produced, rated according the GRADE approach [Quality of evidence: High (A), Moderate (B), Low (C); Strength of Recommendation: Strong (1), Weak (2)]. The statements were subsequently presented in-person at the Prague kick-off meeting, discussed and voted. After two rounds of discussion and voting, all 7 statements reached an overall agreement of 100% on the following issues: needle core/wedge/punch technique representatively [B,1], frozen/paraffin embedded section reliability [B,2], experienced/non-experienced on-call renal pathologist reproducibility/accuracy of the histological report [A,1], glomerulosclerosis/other parameters reproducibility [C,2], digital pathology/light microscopy in the measurement of histological variables [A,1], special stainings/Haematoxylin and Eosin alone comparison [A,1], glomerulosclerosis reliability versus other histological parameters to predict the graft survival, graft function, primary non-function [B,1]. This methodology has allowed to reach a full consensus among European experts on important technical topics regarding pre-implantation biopsy in the ECD graft assessment.
Collapse
Affiliation(s)
- Gianluigi Zaza
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University/Hospital of Foggia, Foggia, Italy
| | - David Cucchiari
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain
| | - Jan Ulrich Becker
- Institut für Pathologie und Molekularpathologie, University Hospital of Cologne, Cologne, Germany
| | - Aiko P. J. de Vries
- Division of Nephrology, Department of Medicine, Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Sandrine Florquin
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jesper Kers
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marion Rabant
- Department of Pathology, Necker-Enfants Malades University Hospital, Paris, France
| | - Michele Rossini
- Nephrology, Dialysis and Transplantation Unit, University/Hospital of Bari, Bari, Italy
| | - Liset Pengel
- Centre for Evidence in Transplantation, Oxford, United Kindom
| | - Lorna Marson
- Department of Surgery, University of Edinburgh, Edinburgh, United Kingdom
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, University of Padova, Padova, Italy
| |
Collapse
|
6
|
de Joode K, van de Geer WS, van Leenders GJLH, Hamberg P, Westgeest HM, Beeker A, Oosting SF, van Rooijen JM, Beerepoot LV, Labots M, Mathijssen RHJ, Lolkema MP, Cuppen E, Sleijfer S, van de Werken HJG, van der Veldt AAM. The genomic and transcriptomic landscape of advanced renal cell cancer for individualized treatment strategies. Sci Rep 2023; 13:10720. [PMID: 37400554 DOI: 10.1038/s41598-023-37764-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/27/2023] [Indexed: 07/05/2023] Open
Abstract
Differences in the clinical course and treatment responses in individual patients with advanced renal cell carcinoma (RCC) can largely be explained by the different genomics of this disease. To improve the personalized treatment strategy and survival outcomes for patients with advanced RCC, the genomic make-up in patients with advanced RCC was investigated to identify putative actionable variants and signatures. In this prospective multicenter study (NCT01855477), whole-genome sequencing (WGS) data of locally advanced and metastatic tissue biopsies and matched whole-blood samples were collected from 91 patients with histopathologically confirmed RCC. WGS data were analyzed for small somatic variants, copy-number alterations and structural variants. For a subgroup of patients, RNA sequencing (RNA-Seq) data could be analyzed. RNA-Seq data were clustered on immunogenic and angiogenic gene expression patterns according to a previously developed angio-immunogenic gene signature. In all patients with papillary and clear cell RCC, putative actionable drug targets were detected by WGS, of which 94% were on-label available. RNA-Seq data of clear cell and papillary RCC were clustered using a previously developed angio-immunogenic gene signature. Analyses of driver mutations and RNA-Seq data revealed clear differences among different RCC subtypes, showing the added value of WGS and RNA-Seq over clinicopathological data. By improving both histological subtyping and the selection of treatment according to actionable targets and immune signatures, WGS and RNA-Seq may improve therapeutic decision making for most patients with advanced RCC, including patients with non-clear cell RCC for whom no standard treatment is available to data. Prospective clinical trials are needed to evaluate the impact of genomic and transcriptomic diagnostics on survival outcome for advanced RCC patients.
Collapse
Affiliation(s)
- K de Joode
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - W S van de Geer
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Cancer Computational Biology Center, Erasmus MC Cancer Institute, University Medical Center, Internal Postal Address NA-1218, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | - P Hamberg
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - H M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - A Beeker
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - S F Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J M van Rooijen
- Department of Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | - L V Beerepoot
- Department of Internal Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - M Labots
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - R H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - M P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Center for Personalized Cancer Treatment, Rotterdam, The Netherlands
| | - E Cuppen
- Center for Molecular Medicine and Oncode Institute, University Medical Center Utrecht, Utrecht, The Netherlands
- Hartwig Medical Foundation, Amsterdam, The Netherlands
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Center for Personalized Cancer Treatment, Rotterdam, The Netherlands
| | - H J G van de Werken
- Cancer Computational Biology Center, Erasmus MC Cancer Institute, University Medical Center, Internal Postal Address NA-1218, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
- Department of Immunology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
| | - A A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- Departments of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
| |
Collapse
|
7
|
Wang CJ, Wetmore JB, Wey A, Miller J, Snyder JJ, Israni AK. Impact of donor kidney biopsy on kidney yield and posttransplant outcomes. Am J Transplant 2023; 23:387-392. [PMID: 36695677 DOI: 10.1016/j.ajt.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 01/03/2023]
Abstract
Procurement biopsy is performed to determine kidney quality, but evidence supporting such association is poor. We investigated the impact of glomerulosclerosis percentage (GS%) on kidney yield and patient outcomes. Information on deceased kidney donors from July 1, 2017, to June 30, 2019, was collected. Association between GS% and kidney yield (number of kidneys procured per donor) and posttransplant graft and patient outcomes were studied. Maximal GS% and minimal GS% were calculated to determine the relationship between GS% and kidney yield; minimal GS% only for correlation with posttransplant outcomes. Multinomial logistic regression and Cox models with least absolute shrinkage and selection operator were used to analyze the association of GS% with kidney yield and posttransplant outcomes, respectively. The kidney yield was 1.63 when maximal GS% and minimal GS% were <5%, but was 0.88 when both GS% were >20%. The hazard ratio for graft failure 1 year after transplant was 1.05 when minimal GS% was 16% to 20%, but was 1.3 for GS% of >20%. The hazard ratio for mortality increased from 1 to 1.2 when minimal GS% reached >20%. In summary, higher GS% was associated with lower kidney yield and inferior posttransplant outcomes. Incorporation of GS% into Scientific Registry of Transplant Recipients models may reassure organ procurement organizations and transplant centers pursuing kidneys with relatively high GS% levels, thereby reducing kidney discard rates.
Collapse
Affiliation(s)
- Connie J Wang
- Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - James B Wetmore
- Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota, USA; Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Andrew Wey
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Jonathan Miller
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Jon J Snyder
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Ajay K Israni
- Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota, USA; Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
| |
Collapse
|
8
|
Vinson AJ, Cardinal H, Parsons C, Tennankore KK, Mainra R, Maru K, Treleaven D, Gill J. Disparities in Deceased Donor Kidney Offer Acceptance: A Survey of Canadian Transplant Nephrologists, General Surgeons and Urologists. Can J Kidney Health Dis 2023; 10:20543581231156855. [PMID: 36861114 PMCID: PMC9969426 DOI: 10.1177/20543581231156855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/19/2022] [Indexed: 02/26/2023] Open
Abstract
Background Significant variability in organ acceptance thresholds have been demonstrated across the United States, but data regarding the rate and rationale for kidney donor organ decline in Canada are lacking. Objective To examine decision making regarding deceased kidney donor acceptance and non-acceptance in a population of Canadian transplant professionals. Design A survey study of theoretical deceased donor kidney cases of increasing complexity. Setting Canadian transplant nephrologists, urologists, and surgeons making donor call decisions responding to an electronic survey between July 22 and October 4, 2022. Participants Invitations to participate were distributed to 179 Canadian transplant nephrologists, surgeons, and urologists through e-mail. Participants were identified by contacting each transplant program and requesting a list of physicians who take donor call. Measurements Survey respondents were asked whether they would accept or decline a given donor, assuming there was a suitable recipient. They were also asked to cite reasons for donor non-acceptance. Methods Donor scenario-specific acceptance rates (total acceptance divided by total number of respondents for a given scenario and overall) and reasons for decline were determined and presented as a percentage of the total cases declined. Results In all, 72 respondents from 7 provinces completed at least one question of the survey, with considerable variability between acceptance rates for centers; the most conservative center declined 60.9% of donor cases, whereas the most aggressive center declined only 28.1%, P-value < .001. There was an increased risk of non-acceptance with advancing age, donation after cardiac death, acute kidney injury, chronic kidney disease, and comorbidities. Limitations As with any survey, there is the potential for participation bias. In addition, this study examines donor characteristics in isolation, however, asks respondent to assume there is a suitable candidate available. In reality, whenever donor quality is considered, it should be considered in the context of the intended recipient. Conclusion In a survey of increasingly medically complex deceased kidney donor cases, there was significant variability in donor decline among Canadian transplant specialists. Given relatively high rates of donor decline and apparent heterogeneity in acceptance decisions, Canadian transplant specialists may benefit from additional education regarding the benefits achieved from even medically complex kidney donors for appropriate candidates relative to remaining on dialysis on the transplant waitlist.
Collapse
Affiliation(s)
- A. J. Vinson
- Nova Scotia Health Authority, Halifax,
Canada,Division of Nephrology, Department of
Medicine, Dalhousie University, Halifax, NS, Canada,A. J. Vinson, Division of Nephrology,
Department of Medicine, Dalhousie University, Room 5081, 5th Floor Dickson
Building, Victoria General Hospital, 5820 University Ave, Halifax, NS B3H 1V8,
Canada.
| | - H. Cardinal
- Centre de recherche du Centre
hospitalier de l’Université de Montréal, QC, Canada
| | - C. Parsons
- Organ and Tissue Donation and
Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - K. K. Tennankore
- Nova Scotia Health Authority, Halifax,
Canada,Division of Nephrology, Department of
Medicine, Dalhousie University, Halifax, NS, Canada
| | - R. Mainra
- Division of Nephrology, Department of
Medicine, University of Saskatchewan, Regina, Canada
| | - K. Maru
- Canadian Blood Services, Ottawa, ON,
Canada
| | - D. Treleaven
- Division of Nephrology, Department of
Medicine, McMaster University, Hamilton, ON, Canada
| | - J. Gill
- Division of Nephrology, Department of
Medicine, The University of British Columbia, Vancouver, Canada
| |
Collapse
|
9
|
Husain SA, King KL, Cron DC, Lentine KL, Adler JT, Mohan S. Influence of organ quality on the observed association between deceased donor kidney procurement biopsy findings and graft survival. Am J Transplant 2022; 22:2842-2854. [PMID: 35946600 DOI: 10.1111/ajt.17167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/17/2022] [Accepted: 08/05/2022] [Indexed: 01/25/2023]
Abstract
Deceased donor kidney procurement biopsies findings are the most common reason for kidney discard. Retrospective studies have found inconsistent associations with post-transplant outcomes but may have been limited by selection bias because kidneys with advanced nephrosclerosis from high-risk donors are typically discarded. We conducted a retrospective cohort study of kidneys transplanted in the United States from 2015 to 2019 with complete biopsy data available, defining "suboptimal histology" as glomerulosclerosis ≥11%, IFTA ≥mild, and/or vascular disease ≥mild. We used time-to-event analyses to determine the association between suboptimal histology and death-censored graft failure after stratification by kidney donor profile index (KDPI) (≤35%, 36%-84%, ≥85%) and final creatinine (<1 mg/dl, 1-2 mg/dl, >2 mg/dl). Among 30 469 kidneys included, 36% had suboptimal histology. In adjusted analyses, suboptimal histology was associated with death-censored graft failure among kidneys with KDPI 36-84% (HR 1.22, 95% CI 1.09-1.36), but not KDPI≤35% (HR 1.24, 0.94-1.64) or ≥ 85% (HR 0.99, 0.81-1.22). Similarly, suboptimal histology was associated with death-censored graft failure among kidneys from donors with creatinine 1-2 mg/dl (HR 1.39, 95% CI 1.20-1.60) but not <1 mg/dl (HR 1.07, 0.93-1.23) or >2 mg/dl (HR 0.95, 0.75-1.20). The association of procurement histology with graft longevity among intermediate-quality kidneys that were likely to be both biopsied and transplanted suggests biopsies provide independent organ quality assessments.
Collapse
Affiliation(s)
- S Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, New York, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
| | - Kristen L King
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, New York, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
| | - David C Cron
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Krista L Lentine
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Joel T Adler
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, New York, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| |
Collapse
|
10
|
Stewart DE, Foutz J, Kamal L, Weiss S, McGehee HS, Cooper M, Gupta G. The Independent Effects of Procurement Biopsy Findings on Ten-Year Outcomes of Extended Criteria Donor Kidney Transplants. Kidney Int Rep 2022; 7:1850-1865. [PMID: 35967103 PMCID: PMC9366372 DOI: 10.1016/j.ekir.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction Methods Results Conclusion
Collapse
|
11
|
Computer-assisted evaluation enhances the quantification of interstitial fibrosis in renal implantation biopsies, measures differences between frozen and paraffin sections, and predicts delayed graft function. J Nephrol 2022; 35:1819-1829. [PMID: 35438423 PMCID: PMC9458593 DOI: 10.1007/s40620-022-01315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/19/2022] [Indexed: 11/24/2022]
Abstract
Background (Pre-)Implantation biopsies provide important data on the quality of donor kidneys. Interstitial fibrosis, as a known predictor for kidney disease progression, is an essential feature of this evaluation. However, the assessment of frozen sections of implantation biopsies is challenging and can result in the disposal of candidate organs. We sought to apply digital image analysis (DIA) to quantify the differences between frozen and paraffin sections when evaluating interstitial fibrosis, identify factors that influence these variations and test the predictive value of the computerised measures. Methods We quantified the differences between frozen and paraffin sections in the same biopsy samples by measuring Sirius red-stained interstitial areas (SRIA) in DIA. We compared them to the original reports, and retrospectively correlated our findings to clinical data, graft function and outcome in 73 patients. Results Frozen sections display a broader interstitial area than paraffin sections, in some cases up to one-third more (mean difference + 7.8%, range − 7 to 29%). No donor-related factors (age or gender, cold ischemia time, or non-heart-beating donor) influenced significantly this difference. Compared to the original assessment of frozen vs paraffin sections in optical microscopy, the DIA of interstitial fibrosis shows a higher consistency (ICC 0.69). Our approach further allows to distinguish SRIA in paraffin sections as an independent predictor for delayed graft function (OR = 1.1; p = 0.028). Conclusions DIA is superior to and more consistent than routine optic microscopy for interstitial fibrosis evaluation. This method could improve implantation biopsy diagnostics and help to reduce disposal of organs. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s40620-022-01315-y.
Collapse
|
12
|
Sarwal RD, Yazar W, Titzler N, Wong J, Lai CH, Chin C, Krieger D, Stoll J, Dias Lourenco F, Sarwal MM, Ghosh S. Through the Looking Glass: Unraveling the Stage-Shift of Acute Rejection in Renal Allografts. J Clin Med 2022; 11:jcm11040910. [PMID: 35207183 PMCID: PMC8879913 DOI: 10.3390/jcm11040910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 02/05/2023] Open
Abstract
Sub-optimal sensitivity and specificity in current allograft monitoring methodologies underscore the need for more accurate and reflexive immunosurveillance to uncover the flux in alloimmunity between allograft health and the onset and progression of rejection. QSant—a urine based multi-analyte diagnostic test—was developed to profile renal transplant health and prognosticate injury, risk of evolution, and resolution of acute rejection. Q-Score—the composite score, across measurements of DNA, protein and metabolic biomarkers in the QSant assay—enables this risk prognostication. The domain of immune quiescence—below a Q-Score threshold of 32—is well established, based on published AUC of 98% for QSant. However, the trajectory of rejection is variable, given that causality is multi-factorial. Injury and subtypes of rejection are captured by the progression of Q-Score. This publication explores the clinical utility of QSant across the alloimmunity gradient of 32–100 for the early diagnosis of allograft injury and rejection.
Collapse
Affiliation(s)
- Reuben D. Sarwal
- NephroSant Inc., 1900 Alameda de las Pulgas, San Mateo, CA 94403, USA; (R.D.S.); (W.Y.); (N.T.); (J.W.); (C.-h.L.); (C.C.); (D.K.); (J.S.); (F.D.L.)
| | - Wanzin Yazar
- NephroSant Inc., 1900 Alameda de las Pulgas, San Mateo, CA 94403, USA; (R.D.S.); (W.Y.); (N.T.); (J.W.); (C.-h.L.); (C.C.); (D.K.); (J.S.); (F.D.L.)
| | - Nicholas Titzler
- NephroSant Inc., 1900 Alameda de las Pulgas, San Mateo, CA 94403, USA; (R.D.S.); (W.Y.); (N.T.); (J.W.); (C.-h.L.); (C.C.); (D.K.); (J.S.); (F.D.L.)
| | - Jeremy Wong
- NephroSant Inc., 1900 Alameda de las Pulgas, San Mateo, CA 94403, USA; (R.D.S.); (W.Y.); (N.T.); (J.W.); (C.-h.L.); (C.C.); (D.K.); (J.S.); (F.D.L.)
| | - Chih-hung Lai
- NephroSant Inc., 1900 Alameda de las Pulgas, San Mateo, CA 94403, USA; (R.D.S.); (W.Y.); (N.T.); (J.W.); (C.-h.L.); (C.C.); (D.K.); (J.S.); (F.D.L.)
| | - Christopher Chin
- NephroSant Inc., 1900 Alameda de las Pulgas, San Mateo, CA 94403, USA; (R.D.S.); (W.Y.); (N.T.); (J.W.); (C.-h.L.); (C.C.); (D.K.); (J.S.); (F.D.L.)
| | - Danielle Krieger
- NephroSant Inc., 1900 Alameda de las Pulgas, San Mateo, CA 94403, USA; (R.D.S.); (W.Y.); (N.T.); (J.W.); (C.-h.L.); (C.C.); (D.K.); (J.S.); (F.D.L.)
| | - Jeff Stoll
- NephroSant Inc., 1900 Alameda de las Pulgas, San Mateo, CA 94403, USA; (R.D.S.); (W.Y.); (N.T.); (J.W.); (C.-h.L.); (C.C.); (D.K.); (J.S.); (F.D.L.)
| | - Francisco Dias Lourenco
- NephroSant Inc., 1900 Alameda de las Pulgas, San Mateo, CA 94403, USA; (R.D.S.); (W.Y.); (N.T.); (J.W.); (C.-h.L.); (C.C.); (D.K.); (J.S.); (F.D.L.)
| | - Minnie M. Sarwal
- NephroSant Inc., 1900 Alameda de las Pulgas, San Mateo, CA 94403, USA; (R.D.S.); (W.Y.); (N.T.); (J.W.); (C.-h.L.); (C.C.); (D.K.); (J.S.); (F.D.L.)
- Department of Surgery, University of California, 400 Parnassus Ave, San Francisco, CA 94143, USA
- Correspondence: (M.M.S.); (S.G.)
| | - Srinka Ghosh
- NephroSant Inc., 1900 Alameda de las Pulgas, San Mateo, CA 94403, USA; (R.D.S.); (W.Y.); (N.T.); (J.W.); (C.-h.L.); (C.C.); (D.K.); (J.S.); (F.D.L.)
- Correspondence: (M.M.S.); (S.G.)
| |
Collapse
|
13
|
Long-standing donor diabetes and pathologic findings are associated with shorter allograft survival in recipients of kidney transplants from diabetic donors. Mod Pathol 2022; 35:128-134. [PMID: 34584213 DOI: 10.1038/s41379-021-00927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/09/2022]
Abstract
Approximately 6% of deceased kidney donors (DKDs) are diabetic; their kidneys may be associated with worse allograft survival, but published studies suggest that recipient diabetes status has a greater impact on mortality and survival. Since biopsy findings are the most common reason for organ discard, we sought to understand histologic and clinical factors that influence graft survival in patients who receive a kidney from a diabetic DKD. We retrospectively reviewed our institutional experience from 2005 to 2019, and re-evaluated pre-implantation and earliest post-transplant biopsies. Histologic findings were compared against a control cohort of non-diabetic DKD. Of 829 adult DKD transplants, 37 (4.5%) came from diabetic donors. There was no significant difference in diabetic vs. non-diabetic DKD graft survival for all-comers; however, when stratified by duration of donor diabetes, donor diabetes ≥6 years was associated with graft failure. In 25 patients with post-transplant biopsies available, diabetic DKD allografts had significantly greater non-glomerular chronic injury than non-diabetic DKD allografts. Moderate arteriolar hyalinosis (in 24%), moderate tubular atrophy and interstitial fibrosis (IFTA, in 36%), and diabetic glomerulopathy (in 24%) on early post-transplant biopsy were associated with allograft failure. Pre-implantation frozen section discrepancies were more common in long-standing donor diabetes, and arteriolar hyalinosis and IFTA scores on frozen accurately prognosticated graft loss. There was no morphologic improvement in lesions of diabetic nephropathy on short-term follow-up. In conclusion, donor diabetes ≥6 years, and histologic findings on frozen section and early post-transplant biopsy are associated with diabetic DKD allograft loss.
Collapse
|
14
|
Neri F, Eccher A, Rigotti P, Girolami I, Zaza G, Gambaro G, Mastrosimini M, Bencini G, Bella CD, Mescoli C, Boschiero L, Marletta S, Tos PAD, Furian L. Advantages of Using a Web-based Digital Platform for Kidney Preimplantation Biopsies. J Pathol Inform 2021; 12:41. [PMID: 34881096 PMCID: PMC8609286 DOI: 10.4103/jpi.jpi_23_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/02/2021] [Accepted: 06/20/2021] [Indexed: 12/13/2022] Open
Abstract
Background: In the setting of kidney transplantation, histopathology of kidney biopsies is a key element in the organ assessment and allocation. Despite the broad diffusion of the Remuzzi–Karpinski score on preimplantation kidney biopsies, scientific evidence of its correlation to the transplantation outcome is controversial. The main issues affecting the prognostic value of histopathology are the referral to general on-call pathologists and the semiquantitative feature of the score, which can raise issues of interpretation. Digital pathology has shown very reliable and effective in the oncological diagnosis and treatment; however, the spread of such technologies is lagging behind in the field of transplantation. The aim of our study was to create a digital online platform where whole-slide images (WSI) of preimplantation kidney biopsies could be uploaded and stored. Methods: We included 210 kidney biopsies collected between January 2015 and December 2019 from the joint collaboration of the transplantation centers of Padua and Verona. The selected slides, stained with hematoxylin and eosin, were digitized and uploaded on a shared web platform. For each case, the on-call pathologists' Remuzzi grades were obtained from the original report, together with the clinical data and the posttransplantation follow-up. Results: The storage of WSI of preimplantation kidney biopsies would have several clinical, scientific, and educational advantages. The clinical utility relies on the possibility to consult online expert pathologists and real-time quality checks of diagnosis. From the perspective of follow-up, the archived digitized biopsies can offer a useful comparison to posttransplantation biopsies. In addition, the digital online platform is a precious tool for multidisciplinary meetings aimed both at the clinical discussion and at the design of research projects. Furthermore, this archive of readily available WSI is an important educational resource for the training of professionals. Conclusions: Finally, the web platform lays the foundation for the introduction of artificial intelligence in the field of transplantation that would help create new diagnostic algorithms and tools with the final aim of increasing the precision of organ assessment and its predictive value for transplant outcome.
Collapse
Affiliation(s)
- Flavia Neri
- Department of Surgical, Oncological and Gastroenterological Sciences, Unit of Kidney and Pancreas Transplantation, University of Padua, Padua, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostic, University and Hospital Trust of Verona, Verona, Italy
| | - Paolo Rigotti
- Department of Surgical, Oncological and Gastroenterological Sciences, Unit of Kidney and Pancreas Transplantation, University of Padua, Padua, Italy
| | - Ilaria Girolami
- Division of Pathology, Central Hospital Bolzano, Bolzano, Italy
| | - Gianluigi Zaza
- Department of General Medicine, Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Gambaro
- Department of General Medicine, Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | - MariaGaia Mastrosimini
- Department of Pathology and Diagnostic, University and Hospital Trust of Verona, Verona, Italy
| | - Giulia Bencini
- Department of Surgical, Oncological and Gastroenterological Sciences, Unit of Kidney and Pancreas Transplantation, University of Padua, Padua, Italy
| | - Caterina Di Bella
- Department of Surgical, Oncological and Gastroenterological Sciences, Unit of Kidney and Pancreas Transplantation, University of Padua, Padua, Italy
| | - Claudia Mescoli
- Department of Medicine, Surgical Pathology and Cytopathology Unit, University of Padua, Padua, Italy
| | - Luigino Boschiero
- Department of Surgical Sciences, Kidney Transplant Center, Hospital Trust of Verona, Verona, Italy
| | - Stefano Marletta
- Department of Pathology and Diagnostic, University and Hospital Trust of Verona, Verona, Italy
| | - Paolo Angelo Dei Tos
- Department of Medicine, Surgical Pathology and Cytopathology Unit, University of Padua, Padua, Italy
| | - Lucrezia Furian
- Department of Surgical, Oncological and Gastroenterological Sciences, Unit of Kidney and Pancreas Transplantation, University of Padua, Padua, Italy
| |
Collapse
|
15
|
Emmons BR, Husain SA, King KL, Adler JT, Mohan S. Variations in deceased donor kidney procurement biopsy practice patterns: A survey of U.S. organ procurement organizations. Clin Transplant 2021; 35:e14411. [PMID: 34196034 PMCID: PMC8556234 DOI: 10.1111/ctr.14411] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Procurement biopsies have become a common practice in the evaluation and allocation of deceased donor kidneys in the United States despite questions about their value and reproducibility. We sought to determine the extent of OPO-level differences in criteria used to decide which deceased donor kidneys undergo a procurement biopsy and to assess the degree of variability in procurement biopsy technique and interpretation across OPOs. METHODS Each of the country's 58 OPOs were invited to participate in the survey. OPOs were divided into two groups based on organ availability ratio and deceased donor kidney discard rate. RESULTS AND CONCLUSIONS Fifty-out-of-fifty-eight invited OPOs (86% response rate) responded to the survey between November 2020 and December 2020. Thirty (60%) OPOs reported that they have formal criteria for performing kidney procurement biopsy, but for 29 of these OPOs, transplant centers can request biopsy on kidneys that do not meet criteria. OPOs used a total of seven different variables and 12 different numerical thresholds to define impaired kidney function that would prompt a procurement biopsy. Additionally, wide variability was seen in biopsy technique and procedures for biopsy interpretation and reporting of findings to transplant programs. These findings identify a clear opportunity for standardization of procurement biopsies to best practices.
Collapse
Affiliation(s)
- Brendan R. Emmons
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY
| | - S. Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY
| | - Kristen L. King
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY
| | - Joel T. Adler
- Department of Surgery, Division of Transplant Surgery, Brigham and Women’s Hospital, Boston, MA
- Center for Surgery and Public Health at Brigham and Women’s Hospital, Boston, MA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| |
Collapse
|
16
|
Liu X, Li M, Wu Y, Chen Y, Hao F, Zhou D, Wang C, Ma C, Shi G, Zhou X. An efficient glomerular object locator for renal whole slide images using proposal-free network and dynamic scale evaluation method. AI COMMUN 2021. [DOI: 10.3233/aic-210073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the diagnosis of chronic kidney disease, glomerulus as the blood filter provides important information for an accurate disease diagnosis. Thus automatic localization of the glomeruli is the necessary groundwork for future auxiliary kidney disease diagnosis, such as glomerular classification and area measurement. In this paper, we propose an efficient glomerular object locator in kidney whole slide image(WSI) based on proposal-free network and dynamic scale evaluation method. In the training phase, we construct an intensive proposal-free network which can learn efficiently the fine-grained features of the glomerulus. In the evaluation phase, a dynamic scale evaluation method is utilized to help the well-trained model find the most appropriate evaluation scale for each high-resolution WSI. We collect and digitalize 1204 renal biopsy microscope slides containing more than 41000 annotated glomeruli, which is the largest number of dataset to our best knowledge. We validate the each component of the proposed locator via the ablation study. Experimental results confirm that the proposed locator outperforms recently proposed approaches and pathologists by comparing F 1 and run time in localizing glomeruli from WSIs at a resolution of 0.25 μm/pixel and thus achieves state-of-the-art performance. Particularly, the proposed locator can be embedded into the renal intelligent auxiliary diagnosis system for renal clinical diagnosis by localizing glomeruli in high-resolution WSIs effectively.
Collapse
Affiliation(s)
- Xueyu Liu
- College of Data Science, Taiyuan University of Technology, Taiyuan, Shanxi, China. E-mail:
| | - Ming Li
- College of Data Science, Taiyuan University of Technology, Taiyuan, Shanxi, China. E-mail:
| | - Yongfei Wu
- College of Data Science, Taiyuan University of Technology, Taiyuan, Shanxi, China. E-mail:
- Faculty of Science and Technology, University of Macau, Taipa, Macau, China. E-mail:
| | - Yilin Chen
- College of Data Science, Taiyuan University of Technology, Taiyuan, Shanxi, China. E-mail:
| | - Fang Hao
- College of Data Science, Taiyuan University of Technology, Taiyuan, Shanxi, China. E-mail:
| | - Daoxiang Zhou
- College of Data Science, Taiyuan University of Technology, Taiyuan, Shanxi, China. E-mail:
| | - Chen Wang
- Department of Pathology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China. E-mail:
| | - Chuanfeng Ma
- College of Data Science, Taiyuan University of Technology, Taiyuan, Shanxi, China. E-mail:
| | - Guangze Shi
- College of Data Science, Taiyuan University of Technology, Taiyuan, Shanxi, China. E-mail:
| | - Xiaoshuang Zhou
- Department of Nephrology, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China. E-mail:
| |
Collapse
|
17
|
Carrara C, Ruggenenti P, Remuzzi G. Redefining the Role of Donor Biopsies in the Process of Kidney Graft Assessment. Nephron Clin Pract 2021; 145:728-731. [PMID: 34293750 DOI: 10.1159/000517730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/07/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Camillo Carrara
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,Unit of Nephrology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Piero Ruggenenti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,Unit of Nephrology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| |
Collapse
|
18
|
Luque Y, Jamme M, Aubert O, Roux A, Martinez F, Amrouche L, Tinel C, Galmiche L, Duong Van Huyen JP, Audenet F, Legendre C, Anglicheau D, Rabant M. A kidney discard decision strategy based on zero-time histology analysis could lead to an unjustified increase in the organ turndown rate among ECD. Transpl Int 2021; 34:1506-1516. [PMID: 34097778 DOI: 10.1111/tri.13933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/15/2021] [Accepted: 05/30/2021] [Indexed: 12/01/2022]
Abstract
The utility of zero-time kidney biopsies (KB) in deciding to accept expanded criteria donor (ECD) kidneys remains controversial. However, zero-time histology is one of the main causes for discarding kidneys in the United States. In a single-centre study, we examined the utility and impact on outcome of the use of frozen section zero-time KB among ECD. Ninety-two zero-time KB were analysed for accept/discard decision between 2005 and 2015 among ECD. 53% of kidneys were rejected after zero-time KB analysis; there was no difference in individual clinical and biological data between accepted/rejected groups. However, histology of rejected kidneys showed more sclerotic glomeruli (20% vs. 8%; P < 0.001), increased interstitial fibrosis (1.25 ± 0.12 vs. 0.47 ± 0.09; P < 0.0001), more arteriosclerosis (2.14 ± 0.17 vs. 1.71 ± 0.11; P = 0.0032) and arteriolar hyalinosis (2.15 ± 0.12 vs. 1.55 ± 0.11; P = 0.0006). Using propensity score matching, we generated a group of 42 kidney allograft recipients who received a transplant matched for donor zero-time histology and clinical characteristics with donors whose kidneys were rejected. Interestingly, their 1- and 5-year graft survival and function were similar to the global cohort of ECD recipients. In conclusion, when performed, zero-time KB was a decisive element for kidney discard decision. However, adverse zero-time histology was not associated with poorer graft survival and kidney function among ECD.
Collapse
Affiliation(s)
- Yosu Luque
- Department of Pathology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Renal Emergencies and Kidney Transplantation Department, Tenon Hospital, Assistance Publique - Hôpitaux de Paris, Inserm, UMR_S1155, Sorbonne Université, Paris, France
| | - Matthieu Jamme
- Intensive care Unit, Poissy-Saint-Germain-en-Laye hospital, Poissy, France
| | - Olivier Aubert
- UMR_S970, Paris Translational Research Center for Organ Transplantation, Inserm, Paris, France.,Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Arthur Roux
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Frank Martinez
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Lucile Amrouche
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Claire Tinel
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Louise Galmiche
- Department of Pathology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - François Audenet
- Urology Department, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Legendre
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Dany Anglicheau
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France.,Necker-Enfants Malades Institute, French National Institute of Health and Medical Research U1151, Paris, France
| | - Marion Rabant
- Department of Pathology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Necker-Enfants Malades Institute, French National Institute of Health and Medical Research U1151, Paris, France
| |
Collapse
|
19
|
Girolami I, Marletta S, Eccher A. Commentary: The Digital Fate of Glomeruli in Renal Biopsy. J Pathol Inform 2021; 12:14. [PMID: 34012718 PMCID: PMC8112342 DOI: 10.4103/jpi.jpi_102_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/09/2021] [Accepted: 01/09/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ilaria Girolami
- Division of Pathology, Central Hospital Bolzano, Bolzano, Italy
| | - Stefano Marletta
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| |
Collapse
|
20
|
Marsh JN, Liu TC, Wilson PC, Swamidass SJ, Gaut JP. Development and Validation of a Deep Learning Model to Quantify Glomerulosclerosis in Kidney Biopsy Specimens. JAMA Netw Open 2021; 4:e2030939. [PMID: 33471115 PMCID: PMC7818108 DOI: 10.1001/jamanetworkopen.2020.30939] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE A chronic shortage of donor kidneys is compounded by a high discard rate, and this rate is directly associated with biopsy specimen evaluation, which shows poor reproducibility among pathologists. A deep learning algorithm for measuring percent global glomerulosclerosis (an important predictor of outcome) on images of kidney biopsy specimens could enable pathologists to more reproducibly and accurately quantify percent global glomerulosclerosis, potentially saving organs that would have been discarded. OBJECTIVE To compare the performances of pathologists with a deep learning model on quantification of percent global glomerulosclerosis in whole-slide images of donor kidney biopsy specimens, and to determine the potential benefit of a deep learning model on organ discard rates. DESIGN, SETTING, AND PARTICIPANTS This prognostic study used whole-slide images acquired from 98 hematoxylin-eosin-stained frozen and 51 permanent donor biopsy specimen sections retrieved from 83 kidneys. Serial annotation by 3 board-certified pathologists served as ground truth for model training and for evaluation. Images of kidney biopsy specimens were obtained from the Washington University database (retrieved between June 2015 and June 2017). Cases were selected randomly from a database of more than 1000 cases to include biopsy specimens representing an equitable distribution within 0% to 5%, 6% to 10%, 11% to 15%, 16% to 20%, and more than 20% global glomerulosclerosis. MAIN OUTCOMES AND MEASURES Correlation coefficient (r) and root-mean-square error (RMSE) with respect to annotations were computed for cross-validated model predictions and on-call pathologists' estimates of percent global glomerulosclerosis when using individual and pooled slide results. Data were analyzed from March 2018 to August 2020. RESULTS The cross-validated model results of section images retrieved from 83 donor kidneys showed higher correlation with annotations (r = 0.916; 95% CI, 0.886-0.939) than on-call pathologists (r = 0.884; 95% CI, 0.825-0.923) that was enhanced when pooling glomeruli counts from multiple levels (r = 0.933; 95% CI, 0.898-0.956). Model prediction error for single levels (RMSE, 5.631; 95% CI, 4.735-6.517) was 14% lower than on-call pathologists (RMSE, 6.523; 95% CI, 5.191-7.783), improving to 22% with multiple levels (RMSE, 5.094; 95% CI, 3.972-6.301). The model decreased the likelihood of unnecessary organ discard by 37% compared with pathologists. CONCLUSIONS AND RELEVANCE The findings of this prognostic study suggest that this deep learning model provided a scalable and robust method to quantify percent global glomerulosclerosis in whole-slide images of donor kidneys. The model performance improved by analyzing multiple levels of a section, surpassing the capacity of pathologists in the time-sensitive setting of examining donor biopsy specimens. The results indicate the potential of a deep learning model to prevent erroneous donor organ discard.
Collapse
Affiliation(s)
- Jon N Marsh
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Institute for Informatics (I 2 ), Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ta-Chiang Liu
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Parker C Wilson
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - S Joshua Swamidass
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Institute for Informatics (I 2 ), Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Joseph P Gaut
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| |
Collapse
|
21
|
Deceased-Donor Kidney Biopsy Scoring Systems for Predicting Future Graft Function: A Comparative Study. Transplant Proc 2020; 53:906-912. [PMID: 33358418 DOI: 10.1016/j.transproceed.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/12/2020] [Accepted: 09/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Deceased-donor kidney quality pretransplantation is considered critical for future graft function. Assessment of donor kidney quality considers clinical and histologic variables. Several models that incorporate a variety of these factors have been proposed to predict long-term graft survival. METHODS We compared the performance metrics of 4 scoring systems models---the Maryland Aggregate Pathology Index, Banff, Remuzzi, and Leuven---for predicting renal allograft survival. In this retrospective cohort study, we analyzed 173 renal allografts that underwent preoperative baseline biopsy. Donor demographics and donor baseline histopathology data were collected and correlated with graft survival posttransplant. RESULTS Among the 4 scoring systems, none were significantly associated with posttransplant graft survival or early graft function. The Maryland Aggregate Pathology Index scoring system had better predictive capacity in receiver operating characteristic curve analysis; however, the utility as a predictor of graft survival was only slightly better than chance. Baseline histologic features were individually analyzed, and it was found that none were associated with graft survival in this cohort. Among donor demographics, none were significantly associated with graft survival. CONCLUSIONS In our study none of the 4 previously proposed predictive models were associated with graft survival after transplantation. Further studies are needed to define new models with stronger predictive value for graft outcome that could help minimize organ discards.
Collapse
|
22
|
Teixeira AC, de Sandes-Freitas TV, Fagundes de Deus E Silva ML, Gomes Prado RM, de Matos Esmeraldo R. Procurement Biopsies Can Predict Unfavorable Outcomes in Kidneys With Low MAPI Score Values. Transplant Proc 2020; 53:602-606. [PMID: 33077181 DOI: 10.1016/j.transproceed.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/31/2020] [Accepted: 09/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are few reports about the usefulness of Maryland Aggregate Pathology Index (MAPI) score in procurement biopsies. This study aimed to evaluate the association between histopathological analysis according to MAPI and unfavorable outcomes in the first year after kidney transplantation (KT). METHODS This retrospective study included deceased-donor KT patients whose grafts were biopsied before transplantation and had low MAPI scores (<8) in frozen sections (FSs). Paraffin sections (PSs) were analyzed after KT. MAPI parameters were global glomerulosclerosis in more than 15% (2 patients), periglomerular fibrosis (4 patients), wall-lumen ratio of arteries >0.5 (2 patients), arteriolar hyalinosis (4 patients), and interstitial scar (3 patients). Multivariable models were used to analyze risk factors for delayed graft function (DGF), prolonged DGF, inferior renal function, and graft loss (P < .05). RESULTS One hundred fifty-nine KTs were included. Donors (n = 120) were predominantly men (70%) and young adults (37.68 ± 12.50 years old) who suffered a traumatic death (55.8%). Recipients were predominantly men (62.26%) and adults (45.70 ± 15.80 years old) with kidney disease of unknown etiology (39.6%). Low rates of agreement between FS and PS were observed for all MAPI criteria, with kappa values ranging from 0.28 to 0.51. Using FS, no histologic parameter was independently associated with outcomes. After adjustment, glomerulosclerosis was an independent risk factor for prolonged DGF (odds ratio = 6.18: 95% confidence interval, 1.27-30.18) and wall-lumen ratio >0.5 for inferior renal function at 1 year (odds ratio = 4.08; 95% confidence interval, 1.21-13.76). CONCLUSION Procurement biopsies can be useful to predict inferior outcomes even in kidneys with low MAPI scores.
Collapse
Affiliation(s)
- André Costa Teixeira
- Department of Clinical Medicine, Faculty of Medicine of Federal University of Ceará, Fortaleza (CE), Brazil.
| | - Tainá Veras de Sandes-Freitas
- Department of Clinical Medicine, Faculty of Medicine of Federal University of Ceará, Fortaleza (CE), Brazil; Division of Transplantation, General Hospital of Fortaleza, Fortaleza (CE), Brazil
| | | | | | | |
Collapse
|
23
|
Husain SA, Shah V, Alvarado Verduzco H, King KL, Brennan C, Batal I, Coley SM, Hall IE, Stokes MB, Dube GK, Crew RJ, Perotte A, Natarajan K, Carpenter D, Sandoval PR, Santoriello D, D’Agati V, Cohen DJ, Ratner L, Markowitz G, Mohan S. Impact of Deceased Donor Kidney Procurement Biopsy Technique on Histologic Accuracy. Kidney Int Rep 2020; 5:1906-1913. [PMID: 33163711 PMCID: PMC7609887 DOI: 10.1016/j.ekir.2020.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/27/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction The factors that influence deceased donor kidney procurement biopsy reliability are not well established. We examined the impact of biopsy technique and pathologist training on procurement biopsy accuracy. Methods We retrospectively identified all deceased donor kidney-only transplants at our center from 2006 to 2016 with both procurement and reperfusion biopsies performed and information available on procurement biopsy technique and pathologist (n = 392). Biopsies were scored using a previously validated system, classifying “suboptimal” histology as the presence of at least 1 of the following: glomerulosclerosis ≥11%, moderate/severe interstitial fibrosis/tubular atrophy, or moderate/severe vascular disease. We calculated relative risk ratios (RRR) to determine the influence of technique (core vs. wedge) and pathologist (renal vs. nonrenal) on concordance between procurement and reperfusion biopsy histologic classification. Results A total of 171 (44%) procurement biopsies used wedge technique, and 221 (56%) used core technique. Results of only 36 biopsies (9%) were interpreted by renal pathologists. Correlation between procurement and reperfusion glomerulosclerosis was poor for both wedge (r2 = 0.11) and core (r2 = 0.14) biopsies. Overall, 34% of kidneys had discordant classification on procurement versus reperfusion biopsy. Neither biopsy technique nor pathologist training was associated with concordance between procurement and reperfusion histology, but a larger number of sampled glomeruli was associated with a higher likelihood of concordance (adjusted RRR = 1.12 per 10 glomeruli, 95% confidence interval = 1.04−1.22). Conclusions Biopsy technique and pathologist training were not associated with procurement biopsy histologic accuracy in this retrospective study. Prospective trials are needed to determine how to optimize procurement biopsy practices.
Collapse
Affiliation(s)
- S. Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
- Correspondence: S. Ali Husain, Division of Nephrology, Department of Medicine, 622 West 168th Street PH4-124, New York, New York 10032, USA.
| | - Vaqar Shah
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Hector Alvarado Verduzco
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Kristen L. King
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
| | - Corey Brennan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
| | - Ibrahim Batal
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Shana M. Coley
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Isaac E. Hall
- Department of Medicine, Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - M. Barry Stokes
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Geoffrey K. Dube
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - R. John Crew
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Adler Perotte
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Dustin Carpenter
- Department of Surgery, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - P. Rodrigo Sandoval
- Department of Surgery, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Dominick Santoriello
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Vivette D’Agati
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - David J. Cohen
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Lloyd Ratner
- Department of Surgery, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Glen Markowitz
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| |
Collapse
|
24
|
Saha-Chaudhuri P, Rabin C, Tchervenkov J, Baran D, Morein J, Sapir-Pichhadze R. Predicting Clinical Outcome in Expanded Criteria Donor Kidney Transplantation: A Retrospective Cohort Study. Can J Kidney Health Dis 2020; 7:2054358120924305. [PMID: 32637142 PMCID: PMC7315672 DOI: 10.1177/2054358120924305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/30/2020] [Indexed: 11/15/2022] Open
Abstract
Background: The gaps in organ supply and demand necessitate the use of expanded criteria donor (ECD) kidneys. Objective: To identify which pre-transplant and post-transplant predictors are most informative regarding short- and long-term ECD transplant outcomes. Design: Retrospective cohort study. Setting: Single center, Quebec, Canada. Patients: The patients were 163 consecutive first-time ECD kidney only transplant recipients who underwent transplantation at McGill University Health Centre (MUHC) between January 1, 2008 and December 31, 2014 and had frozen section wedge procurement biopsies. Measurements: Short-term graft outcomes, including delayed graft function and 1-year estimated glomerular filtration rate (eGFR), as well as long-term outcomes including all-cause graft loss (defined as return to dialysis, retransplantation, and death with function). Methods: Pre-transplant donor, recipient, and transplant characteristics were assessed as predictors of transplant outcomes. The added value of post-transplant predictors, including longitudinal eGFR, was also assessed using time-varying Cox proportional hazards models. Results: In univariate analyses, among the pre-transplant donor characteristics, histopathologic variables did not show evidence of association with delayed graft function, 1-year post-transplant eGFR or all cause graft loss. Recipient age was associated with all-cause graft loss (hazard ratio: 1.038 [95% confidence interval: 1.002-1.075] and the model produced only modest discrimination (C-index: 0.590; standard error [SE]: 0.045). Inclusion of time-dependent post-transplant eGFR improved the model’s prediction accuracy (C-index: 0.711; SE = 0.047). Pre-transplant ECD characteristics were not associated with long-term survival, whereas post-transplant characteristics allowed better model discrimination. Limitations: Single-center study, small sample size, and potential incomplete capture of all covariate data. Conclusions: Incorporation of dynamic prediction models into electronic health records may enable timely mitigation of ECD graft failure risk and/or facilitate planning for renal replacement therapies. Histopathologic findings on preimplantation biopsies have a limited role in predicting long-term ECD outcomes. Trial registration: Not applicable.
Collapse
Affiliation(s)
- Paramita Saha-Chaudhuri
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada
| | - Carly Rabin
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | | | - Dana Baran
- Division of Nephrology and the Multi Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada
| | - Justin Morein
- Department of Medicine, University of Western Ontario, London, ON, Canada
| | - Ruth Sapir-Pichhadze
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada.,Division of Nephrology and the Multi Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.,Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| |
Collapse
|
25
|
Semantic Segmentation Framework for Glomeruli Detection and Classification in Kidney Histological Sections. ELECTRONICS 2020. [DOI: 10.3390/electronics9030503] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The evaluation of kidney biopsies performed by expert pathologists is a crucial process for assessing if a kidney is eligible for transplantation. In this evaluation process, an important step consists of the quantification of global glomerulosclerosis, which is the ratio between sclerotic glomeruli and the overall number of glomeruli. Since there is a shortage of organs available for transplantation, a quick and accurate assessment of global glomerulosclerosis is essential for retaining the largest number of eligible kidneys. In the present paper, the authors introduce a Computer-Aided Diagnosis (CAD) system to assess global glomerulosclerosis. The proposed tool is based on Convolutional Neural Networks (CNNs). In particular, the authors considered approaches based on Semantic Segmentation networks, such as SegNet and DeepLab v3+. The dataset has been provided by the Department of Emergency and Organ Transplantations (DETO) of Bari University Hospital, and it is composed of 26 kidney biopsies coming from 19 donors. The dataset contains 2344 non-sclerotic glomeruli and 428 sclerotic glomeruli. The proposed model consents to achieve promising results in the task of automatically detecting and classifying glomeruli, thus easing the burden of pathologists. We get high performance both at pixel-level, achieving mean F-score higher than 0.81, and Weighted Intersection over Union (IoU) higher than 0.97 for both SegNet and Deeplab v3+ approaches, and at object detection level, achieving 0.924 as best F-score for non-sclerotic glomeruli and 0.730 as best F-score for sclerotic glomeruli.
Collapse
|
26
|
Barabadi M, Shahbaz SK, Foroughi F, Hosseinzadeh M, Nafar M, Yekaninejad MS, Amirzargar A. High Expression of FOXP3 mRNA in Blood and Urine as a Predictive Marker in Kidney Transplantation. Prog Transplant 2019; 28:134-141. [PMID: 29798728 DOI: 10.1177/1526924818765812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diagnosis of allograft dysfunction by noninvasive biomarker tests is preferable to invasive allograft biopsies and has been extensively considered in recent years. This study aims to evaluate blood and urinary forkhead box P3 (FOXP3) messenger RNA (mRNA) expression in renal transplant recipients in an attempt to determine whether differential diagnosis of graft dysfunction is feasible using mRNA profiles. METHODS We analyzed FOXP3 mRNA expression in paired urinary and peripheral blood mononuclear cell (PBMC) samples. A total of 91 kidney transplant recipients enrolled in this study that were classified into 3 groups: biopsy-proven acute rejection (AR; n = 27), chronic allograft nephropathy (n = 19), and well-functioning graft (n = 45). The FOXP3 mRNA expression was quantified by TaqMan probe real-time polymerase chain reaction. RESULTS Acute rejection patients had a higher expression level of transcription factor FOXP3 compared to the chronic nephropathy and control groups. Analysis of receiver operating characteristic curves showed that rejection could be diagnosed with 100% sensitivity and 96% specificity in urine, and 92% sensitivity and 86% specificity in PBMC samples using the optimal FOXP3 mRNA cutoff value. We subdivided the AR group into progressive and nonprogressive patients, which showed a significant difference in FOXP3 mRNA expression. This result confirmed the role of FOXP3 as a diagnostic marker in predicting transplantation outcomes. CONCLUSION Our results suggested that elevated expression of FOXP3 in blood and urine samples from kidney transplant recipients could be a useful noninvasive biomarker to diagnose graft dysfunction.
Collapse
Affiliation(s)
- Mehri Barabadi
- 1 Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Keshavarz Shahbaz
- 1 Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Foroughi
- 2 Department of Immunology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Morteza Hosseinzadeh
- 3 Department of Immunology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohsen Nafar
- 4 Department of Nephrology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mir Saeed Yekaninejad
- 5 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Amirzargar
- 1 Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,6 Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
27
|
Ginley B, Lutnick B, Jen KY, Fogo AB, Jain S, Rosenberg A, Walavalkar V, Wilding G, Tomaszewski JE, Yacoub R, Rossi GM, Sarder P. Computational Segmentation and Classification of Diabetic Glomerulosclerosis. J Am Soc Nephrol 2019; 30:1953-1967. [PMID: 31488606 DOI: 10.1681/asn.2018121259] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/17/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Pathologists use visual classification of glomerular lesions to assess samples from patients with diabetic nephropathy (DN). The results may vary among pathologists. Digital algorithms may reduce this variability and provide more consistent image structure interpretation. METHODS We developed a digital pipeline to classify renal biopsies from patients with DN. We combined traditional image analysis with modern machine learning to efficiently capture important structures, minimize manual effort and supervision, and enforce biologic prior information onto our model. To computationally quantify glomerular structure despite its complexity, we simplified it to three components consisting of nuclei, capillary lumina and Bowman spaces; and Periodic Acid-Schiff positive structures. We detected glomerular boundaries and nuclei from whole slide images using convolutional neural networks, and the remaining glomerular structures using an unsupervised technique developed expressly for this purpose. We defined a set of digital features which quantify the structural progression of DN, and a recurrent network architecture which processes these features into a classification. RESULTS Our digital classification agreed with a senior pathologist whose classifications were used as ground truth with moderate Cohen's kappa κ = 0.55 and 95% confidence interval [0.50, 0.60]. Two other renal pathologists agreed with the digital classification with κ1 = 0.68, 95% interval [0.50, 0.86] and κ2 = 0.48, 95% interval [0.32, 0.64]. Our results suggest computational approaches are comparable to human visual classification methods, and can offer improved precision in clinical decision workflows. We detected glomerular boundaries from whole slide images with 0.93±0.04 balanced accuracy, glomerular nuclei with 0.94 sensitivity and 0.93 specificity, and glomerular structural components with 0.95 sensitivity and 0.99 specificity. CONCLUSIONS Computationally derived, histologic image features hold significant diagnostic information that may augment clinical diagnostics.
Collapse
Affiliation(s)
| | | | - Kuang-Yu Jen
- Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, California
| | - Agnes B Fogo
- Departments of Pathology, Microbiology, and Immunology and Medicine, Vanderbilt University, Nashville, Tennessee
| | - Sanjay Jain
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vighnesh Walavalkar
- Department of Pathology, University of California San Francisco, San Francisco, California; and
| | | | - John E Tomaszewski
- Departments of Pathology and Anatomical Sciences.,Biomedical Informatics, and
| | - Rabi Yacoub
- Division of Nephrology, Department of Medicine, University at Buffalo-The State University of New York, Buffalo, New York
| | - Giovanni Maria Rossi
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,U.O. Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Dipartimento di Medicina e Chirurgia, Università di Parma
| | - Pinaki Sarder
- Departments of Pathology and Anatomical Sciences, .,Biostatistics.,Biomedical Engineering, and
| |
Collapse
|
28
|
Salvadori M, Tsalouchos A. Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best? World J Transplant 2019; 9:62-80. [PMID: 31523629 PMCID: PMC6715576 DOI: 10.5500/wjt.v9.i4.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/21/2019] [Accepted: 07/30/2019] [Indexed: 02/05/2023] Open
Abstract
Organ shortage represents one of the major limitations to the development of kidney transplantation. To increase the donor pool and to answer the ever increasing kidney request, physicians are recurring to marginal kidneys as kidneys from older donors, from hypertensive or diabetic donors and from non-heart beating donors. These kidneys are known to have frequently a worse outcome in the recipients. To date major problem is to evaluate such kidneys in order to use or to discard them before transplantation. The use of such kidneys create other relevant question as whether to use them as single or dual transplant and to allocate them fairly according transplant programs. The pre-transplant histological evaluation, the clinical evaluation of the donor or both the criteria joined has been used and according the time each criterion prevailed over the others. Aim of this review has been to examine the advantages and the drawbacks of any criterion and how they have changed with time. To date any criterion has several limitations and several authors have argued for the development of new guidelines in the field of the kidney evaluation for transplantation. Several authors argue that the use of omic technologies should improve the organ evaluation and studies are ongoing to evaluate these technologies either in the donor urine or in the biopsies taken before transplantation.
Collapse
Affiliation(s)
- Maurizio Salvadori
- Department of Transplantation Renal Unit, Careggi University Hospital, viale Pieraccini 18, Florence 50139, Italy
| | - Aris Tsalouchos
- Nephrology and Dialysis Unit, Saints Cosmas and Damian Hospital, Via Cesare Battisti, Pescia (PT) 2-51017, Italy
| |
Collapse
|
29
|
Hoyer KJR, Dittrich S, Bartram MP, Rinschen MM. Quantification of molecular heterogeneity in kidney tissue by targeted proteomics. J Proteomics 2019. [DOI: 10.1016/j.jprot.2018.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
30
|
Carpenter D, Husain SA, Brennan C, Batal I, Hall IE, Santoriello D, Rosen R, Crew RJ, Campenot E, Dube GK, Radhakrishnan J, Stokes MB, Sandoval PR, D’Agati V, Cohen DJ, Ratner LE, Markowitz G, Mohan S. Procurement Biopsies in the Evaluation of Deceased Donor Kidneys. Clin J Am Soc Nephrol 2018; 13:1876-1885. [PMID: 30361336 PMCID: PMC6302333 DOI: 10.2215/cjn.04150418] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 09/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Biopsies taken at deceased donor kidney procurement continue to be cited as a leading reason for discard; however, the reproducibility and prognostic capability of these biopsies are controversial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We compiled a retrospective, single-institution, continuous cohort of deceased donor kidney transplants performed from 2006 to 2009. Procurement biopsy information-percentage of glomerulosclerosis, interstitial fibrosis/tubular atrophy, and vascular disease-was obtained from the national transplant database. Using univariable, multivariable, and time-to-event analyses for death-censored graft survival, we compared procurement frozen section biopsy reports with reperfusion paraffin-embedded biopsies read by trained kidney pathologists (n=270). We also examined agreement for sequential procurement biopsies performed on the same kidney (n=116 kidneys). RESULTS For kidneys on which more than one procurement biopsy was performed (n=116), category agreement was found in only 64% of cases (κ=0.14). For all kidneys (n=270), correlation between procurement and reperfusion biopsies was poor: overall, biopsies were classified into the same category (optimal versus suboptimal) in only 64% of cases (κ=0.25). This discrepancy was most pronounced when categorizing percentage of glomerulosclerosis, which had 63% agreement (κ=0.15). Interstitial fibrosis/tubular atrophy and vascular disease had agreement rates of 82% (κ=0.13) and 80% (κ=0.15), respectively. Ninety-eight (36%) recipients died, and 56 (21%) allografts failed by the end of follow-up. Reperfusion biopsies were more prognostic than procurement biopsies (hazard ratio for graft failure, 2.02; 95% confidence interval, 1.09 to 3.74 versus hazard ratio for graft failure, 1.30; 95% confidence interval, 0.61 to 2.76), with procurement biopsies not significantly associated with graft failure. CONCLUSIONS We found that procurement biopsies are poorly reproducible, do not correlate well with paraffin-embedded reperfusion biopsies, and are not significantly associated with transplant outcomes.
Collapse
Affiliation(s)
| | - S. Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- The Columbia University Renal Epidemiology Group, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Corey Brennan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and
| | | | - Isaac E. Hall
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Dominick Santoriello
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Raphael Rosen
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - R. John Crew
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Geoffrey K. Dube
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | | | - David J. Cohen
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- The Columbia University Renal Epidemiology Group, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and
| |
Collapse
|
31
|
Teixeira A, Freire de Carvalho C, Mororó G, Pereira L, Lacerda V, Esmeraldo R. Evaluation of Frozen and Paraffin Sections Using the Maryland Aggregate Pathology Index Score in Donor Kidney Biopsy Specimens of a Brazilian Cohort. Transplant Proc 2017; 49:2247-2250. [DOI: 10.1016/j.transproceed.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
32
|
Mohan S, Campenot E, Chiles MC, Santoriello D, Bland E, Crew RJ, Rosenstiel P, Dube G, Batal I, Radhakrishnan J, Sandoval PR, Guarrera J, Stokes MB, D'Agati V, Cohen DJ, Ratner LE, Markowitz G. Association between Reperfusion Renal Allograft Biopsy Findings and Transplant Outcomes. J Am Soc Nephrol 2017; 28:3109-3117. [PMID: 28684646 DOI: 10.1681/asn.2016121330] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 05/06/2017] [Indexed: 11/03/2022] Open
Abstract
Biopsy findings at the time of procurement of deceased donor kidneys remain the most common reason cited for kidney discard. To determine the value of renal allograft histology in predicting outcomes, we evaluated the significance of histologic findings, read by experienced renal pathologists, in 975 postreperfusion biopsy specimens collected from 2005 to 2009 after living donor (n=427) or deceased donor (n=548) renal transplant. We evaluated specimens for the degree of glomerulosclerosis, interstitial fibrosis and tubular atrophy, and vascular disease; specimens with a score of 0 or 1 (scale, 0-3) for each parameter were considered optimal. Overall, 66.3% of living donor kidneys and 50.7% of deceased donor kidneys received an optimal histology score (P<0.001). Irrespective of donor status, suboptimal kidneys came from older donors with a higher incidence of diabetes mellitus, hypertension, and obesity and a higher mean kidney donor risk index (all P<0.001). Death-censored outcomes after transplant differed significantly between optimal and suboptimal kidneys only in the deceased donor transplants (P=0.02). Regardless of histologic classification, outcomes with deceased donor kidneys were inferior to outcomes with living donor kidneys. However, 73.2% of deceased donor kidneys with suboptimal histology remained functional at 5 years. Our findings suggest that histologic findings on postreperfusion biopsy associate with outcomes after deceased donor but not living donor renal transplants, thus donor death and organ preservation-related factors may be of greater prognostic importance. Discarding donated kidneys on the basis of histologic factors may be inappropriate and merits further study.
Collapse
Affiliation(s)
- Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York; .,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and
| | | | - Mariana C Chiles
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | | | - Eric Bland
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | - R John Crew
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | | | - Geoffrey Dube
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | | | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | - P Rodrigo Sandoval
- Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - James Guarrera
- Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | - David J Cohen
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | - Lloyd E Ratner
- Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | | |
Collapse
|
33
|
Sánchez-Escuredo A, Sagasta A, Revuelta I, Rodas LM, Paredes D, Musquera M, Diekmann F, Campistol JM, Solé M, Oppenheimer F. Histopathological evaluation of pretransplant donor biopsies in expanded criteria donors with high kidney donor profile index: a retrospective observational cohort study. Transpl Int 2017; 30:975-986. [PMID: 28403541 DOI: 10.1111/tri.12966] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/24/2017] [Accepted: 03/27/2017] [Indexed: 12/16/2022]
Abstract
There is no consensus on the allocation of renal transplants from expanded criteria donors (ECD). The Kidney Donor Profile Index (KDPI) is used without the need for pretransplant donor biopsies (PTDB). We explored whether PTDB based on Remuzzi Score (RS) allows identification of those marginal kidneys in the highest calculated KDPI risk group (>91%) that appropriate for single transplantation. A retrospective study was conducted of 485 consecutive kidneys procured from a single center and transplanted if the RS was ≤4. We compared 5-year kidney and patients survival between KDPI groups and between RS <4 or =4 in the highest KDPI group. The median KDPI (interquartile range) was 71 (66-76) for KDPI <80% (n = 77), 86 (81-90) for KDPI 81-90% (n = 82), and 97 (94-100) for KDPI >91% (n = 205). Patient survival at 5 years was 85.7%, 85.3%, and 76.09% (P = 0.058) and death-censored graft survival was 84.4%, 86.5%, 73.6% (P = 0.015), respectively for each KDPI group. In >91% calculated KDPI group, there were no differences in graft survival depending on the RS (<4 vs. =4) (P = 0.714). The implementation of PTDB based on RS used for allocation of organs with the highest KDPI range could support to the acceptance of suitable organs for single transplantation with good patient and graft survival rate.
Collapse
Affiliation(s)
- Ana Sánchez-Escuredo
- Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Amaia Sagasta
- Pathology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Ignacio Revuelta
- Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Lida M Rodas
- Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - David Paredes
- Transplant Service Foundation, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Urology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Josep M Campistol
- Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Manel Solé
- Pathology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Federico Oppenheimer
- Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
34
|
Abstract
Zero-time kidney biopsies, obtained at time of transplantation, are performed in many transplant centers worldwide. Decisions on kidney discard, kidney allocation, and choice of peritransplant and posttransplant treatment are sometimes based on the histological information obtained from these biopsies. This comprehensive review evaluates the practical considerations of performing zero-time biopsies, the predictive performance of zero-time histology and composite histological scores, and the clinical utility of these biopsies. The predictive performance of individual histological lesions and of composite scores for posttransplant outcome is at best moderate. No single histological lesion or composite score is sufficiently robust to be included in algorithms for kidney discard. Dual kidney transplantation has been based on histological assessment of zero-time biopsies and improves outcome in individual patients, but the waitlist effects of this strategy remain obscure. Zero-time biopsies are valuable for clinical and translational research purposes, providing insight in risk factors for posttransplant events, and as baseline for comparison with posttransplant histology. The molecular phenotype of zero-time biopsies yields novel therapeutic targets for improvement of donor selection, peritransplant management and kidney preservation. It remains however highly unclear whether the molecular expression variation in zero-time biopsies could become a better predictor for posttransplant outcome than donor/recipient baseline demographic factors.
Collapse
|
35
|
Matos AC, Câmara NO, REQUIãO-MOURA LR, Tonato EJ, Filiponi TC, SOUZA-DURãO M, Malheiros DENISEM, Fregonesi M, Borrelli M, Pacheco-Silva A. Presence of arteriolar hyalinosis in post-reperfusion biopsies represents an additional risk to ischaemic injury in renal transplant. Nephrology (Carlton) 2016; 21:923-929. [DOI: 10.1111/nep.12699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/16/2015] [Accepted: 12/07/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Ana Cristina Matos
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Niels O Câmara
- Nephrology Department; Federal University of São Paulo; São Paulo Brazil
- Immunology Department; São Paulo University; São Paulo Brazil
| | - Lúcio R REQUIãO-MOURA
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Eduardo J Tonato
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Thiago C Filiponi
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Marcelino SOUZA-DURãO
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - DENISE M Malheiros
- Pathology Department; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Maurício Fregonesi
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Milton Borrelli
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Alvaro Pacheco-Silva
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
- Nephrology Department; Federal University of São Paulo; São Paulo Brazil
| |
Collapse
|
36
|
Hosgood SA, Barlow AD, Dormer J, Nicholson ML. The use of ex-vivo normothermic perfusion for the resuscitation and assessment of human kidneys discarded because of inadequate in situ perfusion. J Transl Med 2015; 13:329. [PMID: 26474973 PMCID: PMC4609141 DOI: 10.1186/s12967-015-0691-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/08/2015] [Indexed: 11/10/2022] Open
Abstract
Background Many kidneys are rejected for transplantation due to inadequate in situ perfusion during organ retrieval because of the risk of additional ischaemic injury and microvasculature thrombosis. This study describes the use of ex vivo normothermic perfusion (EVNP) for the resuscitation and assessment of human kidneys that were discarded after inadequate in situ perfusion. Methods Twenty-two human kidneys were retrieved but then deemed unsuitable for transplantation, primarily due to inadequate in situ perfusion. After a period of static cold storage, kidneys were perfused for 60 min with an oxygenated red cell based solution at 36 °C. Results Nineteen out of 22 kidneys (86 %) were from DCD donors. During EVNP, kidneys were assessed and scored based on their macroscopic appearance, measures of renal blood flow and urine production. Kidneys were scored from 1 indicating the least injury to 5, indicating the worst. Twelve kidneys had an EVNP score of 1–2, 7 scored 3–4 and 3 kidneys scored 5. The EVNP score 5 kidneys had a low level of tubular function compared to the score 1–4 kidneys. Their perfusion parameters did not improve during EVNP and they were considered non-transplantable. There was no association between the histological evaluation and EVNP parameters. Conclusion EVNP restores function ex vivo and enables an assessment of kidneys that have been declined for transplantation due to inadequate in situ perfusion.
Collapse
Affiliation(s)
- Sarah A Hosgood
- Transplant Group, Department of Infection, Immunity and Inflammation, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK. .,Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 OQQ, UK.
| | - A D Barlow
- Transplant Group, Department of Infection, Immunity and Inflammation, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK. .,Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 OQQ, UK.
| | - J Dormer
- Department of Medical and Social Care Education, University of Leicester, Leicester, LE1 9HN, UK.
| | - M L Nicholson
- Transplant Group, Department of Infection, Immunity and Inflammation, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK. .,Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 OQQ, UK.
| |
Collapse
|
37
|
Wang CJ, Wetmore JB, Crary GS, Kasiske BL. The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review. Am J Transplant 2015; 15:1903-14. [PMID: 25772854 DOI: 10.1111/ajt.13213] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 01/25/2023]
Abstract
Despite a growing organ shortage in the United States, many deceased donor kidneys removed for transplantation are discarded. Kidney biopsy findings often play a role in these discards, although it is not clear whether biopsies reliably inform acceptance decisions. Therefore, we carried out a systematic review of the medical literature on the utility of both procurement and implantation biopsies for predicting posttransplant outcomes. Between January 1, 1994 and July 1, 2014, 47 studies were published in the English language literature that examined the association between pretransplant donor biopsy findings from 50 or more donors (with more than half being from deceased donors) and either posttransplant graft failure, delayed graft function, or graft function. In general, study quality was poor. All were retrospective or did not indicate if they were prospective. Results were heterogeneous, with authors as often as not concluding that biopsy results did not predict posttransplant outcomes. The percent glomerular sclerosis was most often examined, and failed to predict graft failure in 7 of 14 studies. Of 15 semiquantitative scoring systems proposed, none consistently predicted posttransplant outcomes across studies. Routine use of biopsies to help determine whether or not to transplant a kidney should be reexamined.
Collapse
Affiliation(s)
- C J Wang
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - J B Wetmore
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - G S Crary
- Department of Pathology, Hennepin County Medical Center, Minneapolis, MN
| | - B L Kasiske
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| |
Collapse
|
38
|
Abstract
In patients with end-stage renal disease, kidney transplantation is the best means to extend survival and offer a better quality of life. The current shortage of organs available for transplantation has led to an effort to expand the kidney donor pool, including the use of nonideal donor kidneys. Assessment of the quality of the donated kidney is essential, and would facilitate the decision to transplant a potential organ or discard it. Multiple clinical and histologic parameters have been examined to evaluate the donor kidney and relate the findings to the graft outcome, but clear-cut criteria are yet to be defined.
Collapse
Affiliation(s)
- Nasreen Mohamed
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Amer Bin Thabet Street-mbc035, PO Box 15215, Dammam 31444, Kingdom of Saudi Arabia
| | - Lynn D Cornell
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|