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Mubarak M, Raza A, Rashid R, Shakeel S. Evolution of human kidney allograft pathology diagnostics through 30 years of the Banff classification process. World J Transplant 2023; 13:221-238. [PMID: 37746037 PMCID: PMC10514746 DOI: 10.5500/wjt.v13.i5.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 09/15/2023] Open
Abstract
The second half of the previous century witnessed a tremendous rise in the number of clinical kidney transplants worldwide. This activity was, however, accompanied by many issues and challenges. An accurate diagnosis and appropriate management of causes of graft dysfunction were and still are, a big challenge. Kidney allograft biopsy played a vital role in addressing the above challenge. However, its interpretation was not standardized for many years until, in 1991, the Banff process was started to fill this void. Thereafter, regular Banff meetings took place every 2 years for the past 30 years. Marked changes have taken place in the interpretation of kidney allograft biopsies, diagnosis, and classification of rejection and other non-rejection pathologies from the original Banff 93 classification. This review attempts to summarize those changes for increasing the awareness and understanding of kidney allograft pathology through the eyes of the Banff process. It will interest the transplant surgeons, physicians, pathologists, and allied professionals associated with the care of kidney transplant patients.
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Affiliation(s)
- Muhammed Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
| | - Amber Raza
- Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
| | - Rahma Rashid
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
| | - Shaheera Shakeel
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
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Tang Z, Li T, Feng C, Peng L, Xie X, Peng F, Lan G, Yu S, Wang Y, Dai H. Clinical outcomes for kidney transplantation in 81 adults with IgA nephropathy. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:1017-1025. [PMID: 37724404 PMCID: PMC10930041 DOI: 10.11817/j.issn.1672-7347.2023.230079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVES Immunoglobulin A nephropathy (IgAN) is one of the most common types of kidney disease, and kidney transplantation is the most effective treatment for end-stage renal disease. This study aims to analyze the clinical curative effect of renal transplantation for adults with IgAN and to discuss the efficacy and safety of kidney transplantation for IgAN at the perioperative period and medium- and long-term follow-up. METHODS This retrospective study included the clinical and follow-up data of 81 adult patients with IgAN who underwent kidney transplantation at the Second Xiangya Hospital, Central South University from January 2018 to January 2022. Of the 81 patients whose age at (34.1±9.9) years old, 47 (58.0%) were male. The body mass index was (20.8±3.2) kg/m2, and the human leukocyte antigen (HLA) mismatch number was 3.5±1.2. The estimated glomerular filtration rate (eGFR) and daily 24-hour urine output for the recipients on the 1st, 5th, and 7th day after kidney transplantation and when they were discharged were analyzed. The recovery of the transplanted kidney and occurrence of complications were comprehensively evaluated. The eGFR, urinary protein, and occult blood were evaluated at the 6th, 12th, 24th, 36th, and 48th month and at the last follow-up. RESULTS The follow-up time was (25.7±15.8) months. No primary non-function occurred in any patient during the perioperative period time. Fifty-one (63.0%) patients had immediate graft function recovery, and 16 (19.8%) patients had slow graft function recovery. Delayed recovery of graft function was observed in 14 (17.3%) patients. A total of 19 perioperative complications occurred, including 9 patients with acute rejection, 5 patients with urinary fistula, 1 thrombosis in both lower limbs, and 4 lymphatic fistula. The eGFR at 6th, 12th, 24th, 36th, and 48th month of follow-up were (65.3±22.9), (67.6±23.0), (64.3±21.8), (65.9±24.7), and (68.7±31.2) mL/(min·1.73 m2), respectively. The eGFR remained high during the medium- and long-term follow-ups. At the longest follow-up of 56 months, eGFR fluctuation was still mild, and the positive rate of urine protein and occult blood was low. IgAN recurred in 4 transplanted kidneys, accounting for 4.94% of the total patients, without severe renal insufficiency. Three patients had kidney dysfunction due to severe pneumonia, rejection, and stone in the transplanted kidney. The overall survival rate of the transplanted kidney was higher than 95%, and the survival rate of all patients was 100% till Januray 2022. CONCLUSIONS Renal transplantation for adults with IgAN had a remarkable short-term effect. The recipients can be beneficial significantly to favorable midium- and long-term outcomes. IgAN recurrence is infrequent and rarely causes severe renal function damage.
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Affiliation(s)
- Zhouqi Tang
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011.
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011.
| | - Tengfang Li
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011.
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011.
| | - Chen Feng
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011
| | - Longkai Peng
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011
| | - Xubiao Xie
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011
| | - Fenghua Peng
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011
| | - Gongbin Lan
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011
| | - Shaojie Yu
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011
| | - Yu Wang
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011
| | - Helong Dai
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011.
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011.
- Clinical Immunology Center, Central South University, Changsha 410011, China.
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Zhang J, Chen GD, Qiu J, Tan Y, Liu GC, Chen LZ, Jia W, Fu W, Wang CX. Color Doppler Ultrasound and Hemodynamics for Evaluating Graft Dysfunction in Recurrent Immunoglobulin A Nephropathy. Ann Transplant 2021; 26:e931736. [PMID: 34413279 PMCID: PMC8409140 DOI: 10.12659/aot.931736] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the diagnostic and prognostic utility of color Doppler ultrasound for graft dysfunction in recurrent immunoglobulin A nephropathy (IgAN). MATERIAL AND METHODS We selected a series of 78 biopsies diagnostic of recurrent IgAN following living-donor transplantation from July 2004 to January 2019. Based on Lee's classification, Doppler parameters in different degrees of histopathological injury were retrospectively analyzed. RESULTS The 4-year cumulative graft survival rate after biopsy was 66.3%, and the difference among the Kaplan-Meier curves of Lee's classification (P<0.01) was significant. Doppler parameters showed that echo enhancement, decreasing blood flow distribution, decreasing end-diastolic velocity (EDV) of the main renal artery (MRA), segmental renal atery (SRA) and interlobar renal artery (IRA), and an elevated resistance index (RI) of the arcuate renal artery (ARA) were significantly different among grades I-V of Lee's classification (P<0.05). Logistic multivariate analysis indicated that echo enhancement (HR 13.6, 95% CI 2.7-68.4) and decreasing EDV of the SRA (HR 1.1 for a 1-cm/s, 95% CI 1.0-1.2) were independent predictors of severe injury (IV-V). The ROC curve fitted by echo enhancement and decreasing EDV of the SRA had an area under the curve of 0.87. The cutoff was 17.5 cm/s (decreasing EDV of the SRA) without echo enhancement. The sensitivity and specificity were 72.2% and 91.7%, respectively. CONCLUSIONS Color Doppler ultrasound successfully evaluated the graft dysfunction in recurrent IgAN; a decreasing EDV of the SRA indicated severe histopathological injury and poor prognosis.
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Affiliation(s)
- Jin Zhang
- Department of Urology, Guangzhou Women's and Children's Medical Center, Guangzhou, Guangdong, China (mainland).,Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Guo-Dong Chen
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Jiang Qiu
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Yang Tan
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Guo-Chang Liu
- Department of Urology, Guangzhou Women's and Children's Medical Center, Guangzhou, Guangdong, China (mainland)
| | - Li-Zhong Chen
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Wei Jia
- Department of Urology, Guangzhou Women's and Children's Medical Center, Guangzhou, Guangdong, China (mainland)
| | - Wen Fu
- Department of Urology, Guangzhou Women's and Children's Medical Center, Guangzhou, Guangdong, China (mainland)
| | - Chang-Xi Wang
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
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Sahay M, Kunthara M, Hussain H, Ismal K, Vali PS, Kavadi A, Kumar BV. Posttransplant renal allograft dysfunction – A retrospective observational study. INDIAN JOURNAL OF TRANSPLANTATION 2021. [DOI: 10.4103/ijot.ijot_129_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zhang J, Chen GD, Qiu J, Liu GC, Chen LZ, Fu K, Wu ZX. Graft failure of IgA nephropathy in renal allografts following living donor transplantation: predictive factor analysis of 102 biopsies. BMC Nephrol 2019; 20:446. [PMID: 31796001 PMCID: PMC6889192 DOI: 10.1186/s12882-019-1628-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 11/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background To investigate predictive factors related to graft failure of IgA nephropathy(IgAN) in renal allografts following living donor transplantation. Methods We identified a series of 102 biopsies diagnosed as IgAN in renal allografts following living donor transplantation from July 2004 to January 2017 at our center, and assess the predict value of the Lee’s classification and the 2009 Oxford classification in IgAN in renal allografts, clinical, ultrasonic and pathological characteristics at biopsy and the outcomes were retrospectively analyzed. Results The 5-year graft cumulative survival rate after transplantation was 91.4%. The 4-year graft cumulative survival rate after biopsy diagnosis of IgAN in renal allografts was 59.6%. The mean time ± SD to disease was 4.7 ± 3.5 years. The color doppler ultrasound and blood flow imagine showed the echo enhancement, the reduced blood flow distribution, the reduced peak systolic velocity of main renal artery, and the increased resistance index of arcuate renal artery were valuable in evaluating the graft dysfunction. The Cox multivariate analysis revealed that the 24-h urinary protein level (HR 1.6 for 1-g increase, 95%CI 1.2–2.0), estimated glomerular filtration rate (eGFR) (HR 1.0 for 1-mL/min/1.73 m^2 decline, 95%CI 1.0–1.1), and mesangial C1q deposition (HR 3.0, 95%CI 1.2–7.4) at biopsy were independent predictive factors of graft failure of IgAN in renal allografts. Conclusions IgAN in renal allografts occurred frequently within 5 years after transplantation. The risk of graft failure should be taken seriously in patients who exhibit heavy proteinuria and/or a declined eGFR as the initial symptoms; a high lesion grade (grade IV-V of Lee’s classification) and/or mesangial C1q deposition may also indicated a poor outcome.
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Affiliation(s)
- Jin Zhang
- Department of Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510000, China
| | - Guo-Dong Chen
- Department of Organ Transplant, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
| | - Jiang Qiu
- Department of Organ Transplant, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China.
| | - Guo-Chang Liu
- Department of Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510000, China
| | - Li-Zhong Chen
- Department of Organ Transplant, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
| | - Kai Fu
- Department of Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510000, China
| | - Zi-Xuan Wu
- Department of Organ Transplant, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
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Lee YH, Lee JJ, Lee SY, Jung SW, Kim YG, Moon JY, Kim JS, Hwang HS, Jeong KH, Chung BH, Kim CD, Park JB, Kim YH, Yang DH, Lee SH. Long-term Trends in the Clinicopathologic Features of Kidney Transplant Recipients With Graft Dysfunction. Transplant Proc 2019; 51:3297-3303. [PMID: 31732215 DOI: 10.1016/j.transproceed.2019.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/02/2019] [Accepted: 07/28/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Graft biopsy is the gold standard for the differential diagnosis of graft dysfunction. The time interval between transplant surgery and biopsy often provides clinicians with diagnostic clues. However, the clinicopathologic features of late graft biopsy, especially those obtained at more than 5 years after kidney transplant, are not well understood. MATERIALS AND METHODS We retrospectively collected graft biopsy tissues obtained from kidney transplant recipients who underwent indication biopsy between February 2012 and March 2017. Patients were divided according to their post-transplant period, and their clinical characteristics, pathologic diagnosis, and Banff scores were compared across groups. RESULTS A total of 410 indication biopsy specimens obtained from 321 kidney transplant recipients were analyzed in this study. Overall, the incidence of T cell-mediated rejection, borderline rejection, and BK virus-associated nephropathy decreased while that of antibody-mediated rejection, nonspecific interstitial fibrosis and tubular atrophy, and glomerulonephritis increased over time. Most samples obtained over 5 years after kidney transplant exhibited chronic glomerular and tubulointerstitial injuries irrespective of their pathologic diagnosis. In patients whose post-transplant period was less than 5 years, urine protein-to-creatinine ratio was significantly elevated in the glomerulonephritis and chronic active antibody-mediated rejection groups only. In contrast, patients who underwent graft biopsy more than 5 years after kidney transplant showed significantly high levels of proteinuria irrespective of the pathologic diagnosis, and there was no statistical difference between groups. CONCLUSION We demonstrated that the etiology of graft dysfunction is largely influenced by the biopsy time point.
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Affiliation(s)
- Yu Ho Lee
- Division of Nephrology, Department of Internal Medicine
| | - Jung Jun Lee
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - So-Young Lee
- Division of Nephrology, Department of Internal Medicine
| | - Su Woong Jung
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea
| | - Yang-Gyun Kim
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea
| | - Ju-Young Moon
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea
| | - Jin Sug Kim
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea
| | - Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea
| | - Kyung-Hwan Jeong
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea
| | - Byung Ha Chung
- Transplant Research Center, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan-Duck Kim
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Seoul, Korea
| | - Yeong Hoon Kim
- Division of Nephrology, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Dong Ho Yang
- Division of Nephrology, Department of Internal Medicine
| | - Sang-Ho Lee
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea.
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Beniwal P, Gaur N, Malhotra V, Agrawal D, Singh S, Sharma S, Jhorawat R, Joshi P, Khandelwal S, Gupta V. Significance and safety of renal allograft biopsies: Experience from a tertiary care center in India. INDIAN JOURNAL OF TRANSPLANTATION 2019. [DOI: 10.4103/ijot.ijot_10_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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