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Ricaurte Archila L, Denic A, Mullan AF, Narasimhan R, Bogojevic M, Thompson RH, Leibovich BC, Sangaralingham SJ, Smith ML, Alexander MP, Rule AD. A Higher Foci Density of Interstitial Fibrosis and Tubular Atrophy Predicts Progressive CKD after a Radical Nephrectomy for Tumor. J Am Soc Nephrol 2021; 32:2623-2633. [PMID: 34531177 PMCID: PMC8722813 DOI: 10.1681/asn.2021020267] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/22/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Chronic tubulointerstitial injury on kidney biopsy is usually quantified by the percentage of cortex with interstitial fibrosis/tubular atrophy (IF/TA). Whether other patterns of IF/TA or inflammation in the tubulointerstitium have prognostic importance beyond percentage IF/TA is unclear. METHODS We obtained, stained, and digitally scanned full cortical thickness wedge sections of renal parenchyma from patients who underwent a radical nephrectomy for a tumor over 2000-2015, and morphometrically analyzed the tubulointerstitium of the cortex for percentage IF/TA, IF/TA density (foci per mm2 cortex), percentage subcapsular IF/TA, striped IF/TA, percentage inflammation (both within and outside IF/TA regions), and percentage subcapsular inflammation. Patients were followed with visits every 6-12 months. Progressive CKD was defined as dialysis, kidney transplantation, or 40% decline from the postnephrectomy eGFR. Cox models assessed the risk of CKD or noncancer mortality with morphometric measures of tubulointerstitial injury after adjustment for the percentage IF/TA and clinical characteristics. RESULTS Among 936 patients (mean age, 64 years; postnephrectomy baseline eGFR, 48 ml/min per 1.73m2), 117 progressive CKD events and 183 noncancer deaths occurred over a median 6.4 years. Higher IF/TA density predicted both progressive CKD and noncancer mortality after adjustment for percentage IF/TA and predicted progressive CKD after further adjustment for clinical characteristics. Independent of percentage IF/TA, age, and sex, higher IF/TA density correlated with lower eGFR, smaller nonsclerosed glomeruli, more global glomerulosclerosis, and smaller total cortical volume. CONCLUSIONS Higher density of IF/TA foci (a more scattered pattern with more and smaller foci) predicts higher risk of progressive CKD after radical nephrectomy compared with the same percentage of IF/TA but with fewer and larger foci.
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Affiliation(s)
| | - Aleksandar Denic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Aidan F. Mullan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Ramya Narasimhan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Marija Bogojevic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Maxwell L. Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Mariam P. Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona
| | - Andrew D. Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota,Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
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Farris AB, Vizcarra J, Amgad M, Cooper LAD, Gutman D, Hogan J. Artificial intelligence and algorithmic computational pathology: an introduction with renal allograft examples. Histopathology 2021; 78:791-804. [PMID: 33211332 DOI: 10.1111/his.14304] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Whole slide imaging, which is an important technique in the field of digital pathology, has recently been the subject of increased interest and avenues for utilisation, and with more widespread whole slide image (WSI) utilisation, there will also be increased interest in and implementation of image analysis (IA) techniques. IA includes artificial intelligence (AI) and targeted or hypothesis-driven algorithms. In the overall pathology field, the number of citations related to these topics has increased in recent years. Renal pathology is one anatomical pathology subspecialty that has utilised WSIs and IA algorithms; it can be argued that renal transplant pathology could be particularly suited for whole slide imaging and IA, as renal transplant pathology is frequently classified by use of the semiquantitative Banff classification of renal allograft pathology. Hypothesis-driven/targeted algorithms have been used in the past for the assessment of a variety of features in the kidney (e.g. interstitial fibrosis, tubular atrophy, inflammation); in recent years, the amount of research has particularly increased in the area of AI/machine learning for the identification of glomeruli, for histological segmentation, and for other applications. Deep learning is the form of machine learning that is most often used for such AI approaches to the 'big data' of pathology WSIs, and deep learning methods such as artificial neural networks (ANNs)/convolutional neural networks (CNNs) are utilised. Unsupervised and supervised AI algorithms can be employed to accomplish image or semantic classification. In this review, AI and other IA algorithms applied to WSIs are discussed, and examples from renal pathology are covered, with an emphasis on renal transplant pathology.
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Affiliation(s)
- Alton B Farris
- Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - Juan Vizcarra
- Department of Bioinformatics, Emory University, Atlanta, GA, USA
| | - Mohamed Amgad
- Department of Pathology and Center for Computational Imaging and Signal Analytics, Northwestern University, Chicago, IL, USA
| | - Lee A D Cooper
- Department of Pathology and Center for Computational Imaging and Signal Analytics, Northwestern University, Chicago, IL, USA
| | - David Gutman
- Department of Bioinformatics, Emory University, Atlanta, GA, USA
| | - Julien Hogan
- Department of Surgery, Emory University, Atlanta, GA, USA
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3
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Nishioka S, Ishimura T, Endo T, Yokoyama N, Ogawa S, Fujisawa M. Suppression of Allograft Fibrosis by Regulation of Mammalian Target of Rapamycin-Related Protein Expression in Kidney-Transplanted Recipients Treated with Everolimus and Reduced Tacrolimus. Ann Transplant 2021; 26:e926476. [PMID: 33431785 PMCID: PMC7812696 DOI: 10.12659/aot.926476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Although renoprotective effects of everolimus (EVR) in kidney transplantation (KTx) have been widely reported, its pathophysiological mechanism remains unclear. Material/Methods We compared changes in eGFR (ΔGFR, ml/min/1.73 m2) and the ratio of the fibrotic area in biopsy specimens (ΔFI,%) from 3 months to 3 years after KTx between the EVR+ group (EVR addition and Tac reduction early after KTx, n=32), and the EVR− group (normal Tac without EVR, n=28). We also immunohistochemically evaluated mTOR-related protein expression. Results ΔGFR and ΔFI in the EVR+ vs. EVR− groups were −0.27±6.8 vs. −9.8±12.8 (p<0.001) and 2.4±4.9 vs. 9.5±10.5 (p<0.001), respectively. Phosphorylated mTOR and phosphorylated 4EBP1 expression at 3 years in the EVR+ group was significantly lower than that in the EVR− group. Moreover, in the subgroup analysis comparing ΔGFR and ΔFI among groups stratified by immunosuppressive regimen and mTOR signal enhancement, the ΔFI in patients with EVR+ with decreased mTOR signal enhancement was significantly milder than that in other patients. In addition, in the multivariate analysis, EVR addition was the only independent predictor for allograft fibrosis, whereas the Tac C0 concentration at neither 1 nor 3 years proved to be a risk factor. Conclusions These results suggested that EVR addition and Tac reduction may attenuate kidney allograft fibrosis, and that the suppression of mTOR signaling process may be involved in the anti-fibrotic effect of this immunosuppressive regimen. These results provide suggestions of how to utilize EVR for patients with KTx and improve graft function.
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Affiliation(s)
- Shun Nishioka
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takahito Endo
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Naoki Yokoyama
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoshi Ogawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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4
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Enhancing the Value of Histopathological Assessment of Allograft Biopsy Monitoring. Transplantation 2020; 103:1306-1322. [PMID: 30768568 DOI: 10.1097/tp.0000000000002656] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Traditional histopathological allograft biopsy evaluation provides, within hours, diagnoses, prognostic information, and mechanistic insights into disease processes. However, proponents of an array of alternative monitoring platforms, broadly classified as "invasive" or "noninvasive" depending on whether allograft tissue is needed, question the value proposition of tissue histopathology. The authors explore the pros and cons of current analytical methods relative to the value of traditional and illustrate advancements of next-generation histopathological evaluation of tissue biopsies. We describe the continuing value of traditional histopathological tissue assessment and "next-generation pathology (NGP)," broadly defined as staining/labeling techniques coupled with digital imaging and automated image analysis. Noninvasive imaging and fluid (blood and urine) analyses promote low-risk, global organ assessment, and "molecular" data output, respectively; invasive alternatives promote objective, "mechanistic" insights by creating gene lists with variably increased/decreased expression compared with steady state/baseline. Proponents of alternative approaches contrast their preferred methods with traditional histopathology and: (1) fail to cite the main value of traditional and NGP-retention of spatial and inferred temporal context available for innumerable objective analyses and (2) belie an unfamiliarity with the impact of advances in imaging and software-guided analytics on emerging histopathology practices. Illustrative NGP examples demonstrate the value of multidimensional data that preserve tissue-based spatial and temporal contexts. We outline a path forward for clinical NGP implementation where "software-assisted sign-out" will enable pathologists to conduct objective analyses that can be incorporated into their final reports and improve patient care.
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Girolami I, Parwani A, Barresi V, Marletta S, Ammendola S, Stefanizzi L, Novelli L, Capitanio A, Brunelli M, Pantanowitz L, Eccher A. The Landscape of Digital Pathology in Transplantation: From the Beginning to the Virtual E-Slide. J Pathol Inform 2019; 10:21. [PMID: 31367473 PMCID: PMC6639852 DOI: 10.4103/jpi.jpi_27_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background Digital pathology has progressed over the last two decades, with many clinical and nonclinical applications. Transplantation pathology is a highly specialized field in which the majority of practicing pathologists do not have sufficient expertise to handle critical needs. In this context, digital pathology has proven to be useful as it allows for timely access to expert second-opinion teleconsultation. The aim of this study was to review the experience of the application of digital pathology to the field of transplantation. Methods Papers on this topic were retrieved using PubMed as a search engine. Inclusion criteria were the presence of transplantation setting and the use of any type of digital image with or without the use of image analysis tools; the search was restricted to English language papers published in the 25 years until December 31, 2018. Results Literature regarding digital transplant pathology is mostly about the digital interpretation of posttransplant biopsies (75 vs. 19), with 15/75 (20%) articles focusing on agreement/reproducibility. Several papers concentrated on the correlation between biopsy features assessed by digital image analysis (DIA) and clinical outcome (45/75, 60%). Whole-slide imaging (WSI) only appeared in recent publications, starting from 2011 (13/75, 17.3%). Papers dealing with preimplantation biopsy are less numerous, the majority (13/19, 68.4%) of which focus on diagnostic agreement between digital microscopy and light microscopy (LM), with WSI technology being used in only a small quota of papers (4/19, 21.1%). Conclusions Overall, published studies show good concordance between digital microscopy and LM modalities for diagnosis. DIA has the potential to increase diagnostic reproducibility and facilitate the identification and quantification of histological parameters. Thus, with advancing technology such as faster scanning times, better image resolution, and novel image algorithms, it is likely that WSI will eventually replace LM.
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Affiliation(s)
- Ilaria Girolami
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Anil Parwani
- Department of Pathology, Ohio State University, Columbus, Ohio, USA
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Marletta
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Serena Ammendola
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Lavinia Stefanizzi
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Novelli
- Department of Translational Medicine and Surgery, Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy
| | - Arrigo Capitanio
- Department of Clinical Pathology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Liron Pantanowitz
- Department of Pathology, UPMC Shadyside Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Albino Eccher
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
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Zhang X, Yang Z, Heng Y, Miao C. MicroRNA‑181 exerts an inhibitory role during renal fibrosis by targeting early growth response factor‑1 and attenuating the expression of profibrotic markers. Mol Med Rep 2019; 19:3305-3313. [PMID: 30816527 DOI: 10.3892/mmr.2019.9964] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 02/07/2019] [Indexed: 11/06/2022] Open
Abstract
Progressive renal fibrosis is a common complication of chronic kidney disease that results in end‑stage renal disorder. It is well established that several microRNAs (miRs) function as critical regulators implicated in fibrotic diseases. However, the role of miR‑181 in the development and progression of renal fibrosis remains unclear, and the precise mechanism has not yet been fully defined. The present study identified the functional implications of miR‑181 expression during renal fibrosis. miR‑181 exhibited significantly reduced expression in the serum of renal fibrosis patients and in the kidneys of mice with unilateral ureteral obstruction (UUO). In addition, miR‑181 downregulated the expression of human α‑smooth muscle actin (α‑SMA) in response to angiotensin II stimulation. Transfection with miR‑181 mimics significantly suppressed the expression levels of α‑SMA, connective tissue growth factor, collagen type I α1 (COL1A1) and collagen type III α1 (COL3A1) in NRK49F cells. Notably, early growth response factor‑1 (Egr1) was identified as a direct target gene of miR‑181. Furthermore, in vivo experiments revealed that treatment with miR‑181 agonist strongly rescued kidney impairment induced by UUO, as supported by Masson's trichrome staining of kidney tissues and reverse transcription‑quantitative polymerase chain reaction analysis of COL1A1 and COL3A1 mRNA levels. Therefore, miR‑181 may be regarded as an important mediator in the control of profibrotic markers during renal fibrosis via binding to Egr1, and may be a promising new target in the diagnosis and therapy of renal fibrosis.
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Affiliation(s)
- Xiaoyan Zhang
- Department of Nephrology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Zhenning Yang
- School of Clinical Medicine, Norman Bethune Health Science Center of Jilin University, Changchun, Jilin 130022, P.R. China
| | - Yanyan Heng
- Department of Nephrology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Congxiu Miao
- Department of Scientific Research, Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
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Berchtold L, Friedli I, Crowe LA, Martinez C, Moll S, Hadaya K, de Perrot T, Combescure C, Martin PY, Vallée JP, de Seigneux S. Validation of the corticomedullary difference in magnetic resonance imaging-derived apparent diffusion coefficient for kidney fibrosis detection: a cross-sectional study. Nephrol Dial Transplant 2019; 35:937-945. [DOI: 10.1093/ndt/gfy389] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/15/2018] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Kidney cortical interstitial fibrosis (IF) is highly predictive of renal prognosis and is currently assessed by the evaluation of a biopsy. Diffusion magnetic resonance imaging (MRI) is a promising tool to evaluate kidney fibrosis via the apparent diffusion coefficient (ADC), but suffers from inter-individual variability. We recently applied a novel MRI protocol to allow calculation of the corticomedullary ADC difference (ΔADC). We here present the validation of ΔADC for fibrosis assessment in a cohort of 164 patients undergoing biopsy and compare it with estimated glomerular filtration rate (eGFR) and other plasmatic parameters for the detection of fibrosis.
Methods
This monocentric cross-sectional study included 164 patients undergoing renal biopsy at the Nephrology Department of the University Hospital of Geneva between October 2014 and May 2018. Patients underwent diffusion-weighted imaging, and T1 and T2 mappings, within 1 week after biopsy. MRI results were compared with gold standard histology for fibrosis assessment.
Results
Absolute cortical ADC or cortical T1 values correlated poorly to IF assessed by the biopsy, whereas ΔADC was highly correlated to IF (r=−0.52, P < 0.001) and eGFR (r = 0.37, P < 0.01), in both native and allograft patients. ΔT1 displayed a lower, but significant, correlation to IF and eGFR, whereas T2 did not correlate to IF nor to eGFR. ΔADC, ΔT1 and eGFR were independently associated with kidney fibrosis, and their combination allowed detection of extensive fibrosis with good specificity.
Conclusion
ΔADC is better correlated to IF than absolute cortical or medullary ADC values. ΔADC, ΔT1 and eGFR are independently associated to IF and allow the identification of patients with extensive IF.
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Affiliation(s)
- Lena Berchtold
- Service and Laboratory of Nephrology, Department for Statistics, Department of Internal Medicine Specialties and of Physiology and Metabolism, University Hospital and University of Geneva, Geneva, Switzerland
| | - Iris Friedli
- Service of Radiology, Department for Statistics, Department of Radiology and Medical Informatics, University Hospital and University of Geneva, Geneva, Switzerland
| | - Lindsey A Crowe
- Service of Radiology, Department for Statistics, Department of Radiology and Medical Informatics, University Hospital and University of Geneva, Geneva, Switzerland
| | - Chantal Martinez
- Service and Laboratory of Nephrology, Department for Statistics, Department of Internal Medicine Specialties and of Physiology and Metabolism, University Hospital and University of Geneva, Geneva, Switzerland
| | - Solange Moll
- Department of Clinical Pathology, Institute of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland
| | - Karine Hadaya
- Service and Laboratory of Nephrology, Department for Statistics, Department of Internal Medicine Specialties and of Physiology and Metabolism, University Hospital and University of Geneva, Geneva, Switzerland
| | - Thomas de Perrot
- Service of Radiology, Department for Statistics, Department of Radiology and Medical Informatics, University Hospital and University of Geneva, Geneva, Switzerland
| | - Christophe Combescure
- CRC & Division of Clinical-Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre-Yves Martin
- Service and Laboratory of Nephrology, Department for Statistics, Department of Internal Medicine Specialties and of Physiology and Metabolism, University Hospital and University of Geneva, Geneva, Switzerland
| | - Jean-Paul Vallée
- Service of Radiology, Department for Statistics, Department of Radiology and Medical Informatics, University Hospital and University of Geneva, Geneva, Switzerland
| | - Sophie de Seigneux
- Service and Laboratory of Nephrology, Department for Statistics, Department of Internal Medicine Specialties and of Physiology and Metabolism, University Hospital and University of Geneva, Geneva, Switzerland
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Influence of CYP3A5 genetic differences in tacrolimus on quantitative interstitial fibrosis and long-term graft function in kidney transplant recipients. Int Immunopharmacol 2018; 58:57-63. [PMID: 29550576 DOI: 10.1016/j.intimp.2018.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/20/2018] [Accepted: 03/05/2018] [Indexed: 01/03/2023]
Abstract
The impact of CYP3A5 polymorphisms on clinical outcomes is controversial. The present study investigated the impact of CYP3A5 genetic differences on the development of interstitial fibrosis (IF) from 0 h to 1 year post-transplantation in biopsy sections from 96 living kidney recipients under the same target trough regimen of tacrolimus. The relationships between CYP3A5 polymorphisms and long-term graft function and death-censored graft survival were also examined. A quantitative analysis of IF was performed using computer-assisted imaging on virtual slides. Percent IF (%IF) in the cortical region at 0 h was defined as the baseline, and increases in the ratio of %IF 1 year post-transplantation were calculated. The relationships between CYP3A5 genetic differences and the development of IF, the incidence of clinical events, and the long-term function and death-censored survival of grafts were assessed. The mean increase in the ratio of %IF from 0 h to 1 year was 1.38 ± 0.74-fold. Despite therapeutic drug monitoring (TDM), trough levels of tacrolimus were lower in carriers with the CYP3A5*1 allele (expressers) than in those with the CTP3A5*3/*3 genotype (non-expressers) throughout the 1-year post-transplantation period. However, CYP3A5 genetic differences were not associated with the development of IF, any clinical events, or the long-term function and survival of grafts. The clinical impact of CYP3A5 genetic differences may be small under the current immunosuppressive regimen consisting of mycophenolate mofetil, steroids, basiliximab, and lower target trough levels of tacrolimus with suitable TDM in a low immunological risk population.
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Tey WK, Kuang YC, Ooi MPL, Khoo JJ. Automated quantification of renal interstitial fibrosis for computer-aided diagnosis: A comprehensive tissue structure segmentation method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 155:109-120. [PMID: 29512490 DOI: 10.1016/j.cmpb.2017.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/01/2017] [Accepted: 12/11/2017] [Indexed: 06/08/2023]
Abstract
UNLABELLED Interstitial fibrosis in renal biopsy samples is a scarring tissue structure that may be visually quantified by pathologists as an indicator to the presence and extent of chronic kidney disease. The standard method of quantification by visual evaluation presents reproducibility issues in the diagnoses. This study proposes an automated quantification system for measuring the amount of interstitial fibrosis in renal biopsy images as a consistent basis of comparison among pathologists. The system extracts and segments the renal tissue structures based on colour information and structural assumptions of the tissue structures. The regions in the biopsy representing the interstitial fibrosis are deduced through the elimination of non-interstitial fibrosis structures from the biopsy area and quantified as a percentage of the total area of the biopsy sample. A ground truth image dataset has been manually prepared by consulting an experienced pathologist for the validation of the segmentation algorithms. The results from experiments involving experienced pathologists have demonstrated a good correlation in quantification result between the automated system and the pathologists' visual evaluation. Experiments investigating the variability in pathologists also proved the automated quantification error rate to be on par with the average intra-observer variability in pathologists' quantification. BACKGROUND AND OBJECTIVE Interstitial fibrosis in renal biopsy samples is a scarring tissue structure that may be visually quantified by pathologists as an indicator to the presence and extent of chronic kidney disease. The standard method of quantification by visual evaluation presents reproducibility issues in the diagnoses due to the uncertainties in human judgement. METHODS An automated quantification system for accurately measuring the amount of interstitial fibrosis in renal biopsy images is presented as a consistent basis of comparison among pathologists. The system identifies the renal tissue structures through knowledge-based rules employing colour space transformations and structural features extraction from the images. In particular, the renal glomerulus identification is based on a multiscale textural feature analysis and a support vector machine. The regions in the biopsy representing interstitial fibrosis are deduced through the elimination of non-interstitial fibrosis structures from the biopsy area. The experiments conducted evaluate the system in terms of quantification accuracy, intra- and inter-observer variability in visual quantification by pathologists, and the effect introduced by the automated quantification system on the pathologists' diagnosis. RESULTS A 40-image ground truth dataset has been manually prepared by consulting an experienced pathologist for the validation of the segmentation algorithms. The results from experiments involving experienced pathologists have demonstrated an average error of 9 percentage points in quantification result between the automated system and the pathologists' visual evaluation. Experiments investigating the variability in pathologists involving samples from 70 kidney patients also proved the automated quantification error rate to be on par with the average intra-observer variability in pathologists' quantification. CONCLUSIONS The accuracy of the proposed quantification system has been validated with the ground truth dataset and compared against the pathologists' quantification results. It has been shown that the correlation between different pathologists' estimation of interstitial fibrosis area has significantly improved, demonstrating the effectiveness of the quantification system as a diagnostic aide.
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Affiliation(s)
- Wei Keat Tey
- Advanced Engineering Platform and Department of Electrical and Computer Systems Engineering, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Malaysia.
| | - Ye Chow Kuang
- Advanced Engineering Platform and Department of Electrical and Computer Systems Engineering, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Malaysia
| | - Melanie Po-Leen Ooi
- Unitec Institute of Technology, 139 Carrington Road, Mount Albert, Auckland 1025, New Zealand
| | - Joon Joon Khoo
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia
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Delsuc C, Faure A, Berthiller J, Dorez D, Matillon X, Meas-Yedid V, Floccard B, Marcotte G, Labeye V, Rabeyrin M, Codas R, Chauvet C, Robinson P, Morelon E, Badet L, Hanf W, Rimmelé T. Uncontrolled donation after circulatory death: comparison of two kidney preservation protocols on graft outcomes. BMC Nephrol 2018; 19:3. [PMID: 29310591 PMCID: PMC5759186 DOI: 10.1186/s12882-017-0805-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 12/21/2017] [Indexed: 12/13/2022] Open
Abstract
Background Kidney transplantation following uncontrolled donation after circulatory death (uDCD) presents a high risk of delayed graft function due to prolonged warm ischemia time. In order to minimise the effects of ischemia/reperfusion injury during warm ischemia, normothermic recirculation recently replaced in situ perfusion prior to implantation in several institutions. The aim of this study was to compare these preservation methods on kidney graft outcomes. Methods The primary endpoint was the one-year measured graft filtration rate (mGFR). We collected retrospective data from 64 consecutive uDCD recipients transplanted over a seven-year period in a single centre. Results Thirty-two grafts were preserved by in situ perfusion and 32 by normothermic recirculation. The mean ± SD mGFR at 1 year post-transplantation was 43.0 ± 12.8 mL/min/1.73 m2 in the in situ perfusion group and 53.2 ± 12.8 mL/min/1.73 m2 in the normothermic recirculation group (p = 0.01). Estimated GFR levels were significantly higher in the normothermic recirculation group at 12 months (p = 0.01) and 24 months (p = 0.03) of follow-up. We did not find any difference between groups regarding patient and graft survival, delayed graft function, graft rejection, or interstitial fibrosis. Conclusions Function of grafts preserved by normothermic recirculation was better at 1 year and the results suggest that this persists at 2 years, although no difference was found in short-term outcomes. Despite the retrospective design, this study provides an additional argument in favour of normothermic recirculation. Electronic supplementary material The online version of this article (10.1186/s12882-017-0805-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claire Delsuc
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service d'Anesthésie Réanimation, Lyon, France. .,EA 7426 (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux) "Pathophysiology of Injury-Induced Immunosuppression - PI3", Lyon, France. .,Service d'Anesthésie Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.
| | - Alexandre Faure
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service d'Anesthésie Réanimation, Lyon, France
| | - Julien Berthiller
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service d'Epidémiologie Clinique, Pôle Information Médicale Evaluation Recherche (unité statistiques), Lyon, France
| | - Didier Dorez
- Centre Hospitalier Annecy Genevois, service de Coordination des Prélèvements d'Organes et de Tissus, Metz-Tessy, France
| | - Xavier Matillon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service d'Urologie, Lyon, France
| | | | - Bernard Floccard
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service d'Anesthésie Réanimation, Lyon, France
| | - Guillaume Marcotte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service d'Anesthésie Réanimation, Lyon, France
| | - Vanessa Labeye
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service de Coordination des Prélèvements d'Organes et de Tissus, Lyon, France
| | - Maud Rabeyrin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service d'Anatomopathologie, Lyon, France
| | - Ricardo Codas
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service d'Urologie, Lyon, France
| | - Cécile Chauvet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service de Transplantation, Néphrologie et Immunologie Clinique, Lyon, France
| | - Philip Robinson
- Hospices Civils de Lyon, Direction de la Recherche Clinique et de l'Innovation, Lyon, France
| | - Emmanuel Morelon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service de Transplantation, Néphrologie et Immunologie Clinique, Lyon, France
| | - Lionel Badet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service d'Urologie, Lyon, France
| | - William Hanf
- Centre Hospitalier Alpes-Léman, service de Néphrologie, Contamine-sur-Arve, France
| | - Thomas Rimmelé
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service d'Anesthésie Réanimation, Lyon, France.,EA 7426 (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux) "Pathophysiology of Injury-Induced Immunosuppression - PI3", Lyon, France
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11
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Development of CD3 cell quantitation algorithms for renal allograft biopsy rejection assessment utilizing open source image analysis software. Virchows Arch 2017; 472:259-269. [DOI: 10.1007/s00428-017-2260-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/29/2017] [Accepted: 10/24/2017] [Indexed: 12/18/2022]
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Matillon X, Danjou F, Petruzzo P, Thaunat O, Rimmele T, Delsuc C, Faure A, Rabeyrin M, Meas Yedid V, Hanf W, Morelon E, Badet L, Codas R. Hypothermic pulsatile preservation of kidneys from uncontrolled deceased donors after cardiac arrest - a retrospective study. Transpl Int 2017; 30:1284-1291. [DOI: 10.1111/tri.13024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/04/2017] [Accepted: 08/05/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Xavier Matillon
- Department of Urology and Transplantation; Hôpital Edouard Herriot; Hospices Civils de Lyon; Lyon France
| | - Fabrice Danjou
- Département d'Information Médicale; Hôpital Saint Camille; Bry-sur-Marne France
| | - Palmina Petruzzo
- Department of Urology and Transplantation; Hôpital Edouard Herriot; Hospices Civils de Lyon; Lyon France
- Department of Surgery; University of Cagliari; Cagliari Italy
| | - Olivier Thaunat
- Service de Néphrologie, Transplantation et Immunologie Clinique; Hôpital Edouard Herriot; Hospices Civils de Lyon; Lyon France
- INSERM U1111; Centre International de Recherche en Infectiologie (CIRI); Ecole Normale Supérieure de Lyon; CNRS, UMR 5308; Lyon France
- Université Claude Bernard - Lyon I; Lyon France
| | - Thomas Rimmele
- Department of Anaesthesiology and Intensive Care; Hôpital Edouard Herriot; Hospices Civils de Lyon; Lyon France
| | - Claire Delsuc
- Department of Anaesthesiology and Intensive Care; Hôpital Edouard Herriot; Hospices Civils de Lyon; Lyon France
| | - Alexandre Faure
- Department of Anaesthesiology and Intensive Care; Hôpital Edouard Herriot; Hospices Civils de Lyon; Lyon France
| | - Maud Rabeyrin
- Department of Pathology; Hopital Edouard Herriot; Hospices Civils de Lyon; Lyon France
| | - Vannary Meas Yedid
- Unité d'Analyse d'Images Biologiques; Institut Pasteur; CNRS URA 2582; Paris France
| | - William Hanf
- Department of Nephrology; Alpes-Leman Hospital; Contamine-sur-Arve France
| | - Emmanuel Morelon
- Service de Néphrologie, Transplantation et Immunologie Clinique; Hôpital Edouard Herriot; Hospices Civils de Lyon; Lyon France
- INSERM U1111; Centre International de Recherche en Infectiologie (CIRI); Ecole Normale Supérieure de Lyon; CNRS, UMR 5308; Lyon France
- Université Claude Bernard - Lyon I; Lyon France
| | - Lionel Badet
- Department of Urology and Transplantation; Hôpital Edouard Herriot; Hospices Civils de Lyon; Lyon France
| | - Ricardo Codas
- Department of Urology and Transplantation; Hôpital Edouard Herriot; Hospices Civils de Lyon; Lyon France
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Nara M, Komatsuda A, Numakura K, Saito M, Inoue T, Niioka T, Miura M, Mitobe Y, Okuyama S, Takahashi N, Habuchi T, Satoh S. Quantification of Interstitial Fibrosis in Renal Allografts and Clinical Correlates of Long-Term Graft Function. Am J Nephrol 2017; 46:187-194. [PMID: 28848141 DOI: 10.1159/000479983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/25/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The present study investigated interstitial fibrosis (IF) in 144 kidney recipients 0 h and 1 year post transplantation and assessed relationships with Banff code scores, clinical parameters, and long-term graft function. METHODS A quantitative analysis of IF was performed using the computer-assisted imaging of Sirius red-stained biopsy samples. Percent IF (%IF) in the cortical region was assessed at 0 h and 1 year, and an increase in the ratio of %IF from 0 h to 1 year was calculated. The relationship between %IF and Banff code scores was analyzed. Demographics and trough concentrations of tacrolimus were tested as risk factors in the top 20 patients with increases in %IF. The influence of increases in the ratio of %IF at 1 year on long-term graft function and survival was also assessed in these 20 patients. RESULTS Median %IF at 0 h and 1 year were 1.55 and 2.80%, respectively. No correlation was found between %IF and Banff code scores. The mean increase in the ratio of %IF from 0 h to 1 year was 4.31-fold. The increase in %IF in the top 20 patients correlated with diabetes mellitus. Graft function, but not graft survival, was lower in the top 20 patients for 10 years post transplantation. CONCLUSIONS A correlation was not found between %IF and Banff code scores. Greater increases in %IF within 1 year post transplantation may influence long-term graft survival. Computer-analyzed increases in %IF at 1 year may be a surrogate marker for long-term graft function.
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Affiliation(s)
- Mizuho Nara
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
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Dörje C, Reisaeter AV, Dahle DO, Mjøen G, Midtvedt K, Holdaas H, Flaa-Johnsen L, Syversveen T, Hartmann A, Jenssen T, Scott H, Reinholt FP. Total inflammation in early protocol kidney graft biopsies does not predict progression of fibrosis at one year post-transplant. Clin Transplant 2016; 30:802-9. [PMID: 27101801 DOI: 10.1111/ctr.12753] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There is an uncertainty whether total inflammation in early protocol kidney graft biopsies is associated with fibrosis progression. We investigated whether total inflammation, both in fibrotic and non-fibrotic areas, at week 6 would predict fibrosis progression at one yr post-transplant. METHODS We included 156 single adult ABO compatible kidney recipients with adequate week 6 and one yr transplant protocol biopsies (312 biopsies). Biopsies were scored according to the current Banff criteria. In addition, fibrosis and inflammation in fibrotic and non-fibrotic areas were scored in a 10-grade semi-quantitative eyeballing system from 0% to 100%. RESULTS Fibrosis increased significantly from week 6 to one yr both by the 10-grade scoring system from 0.69 ± 1.07 to 1.45 ± 1.86, (mean ± SD), p < 0.001 and by Banff interstitial fibrosis (ci) scoring 0.81 ± 0.65 to 1.13 ± 0.87, p < 0.001. The 10-grade scoring system detected a larger proportion of fibrosis progressors than the Banff scoring 40.4% vs. 35.5%, p < 0.001. No significant positive association was found between inflammation at week 6 and progression of fibrosis in either of the scoring systems. CONCLUSIONS Total inflammation in kidney transplant biopsies at week 6 did not predict progression of fibrosis at one yr post-transplant.
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Affiliation(s)
- Christina Dörje
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Dag Olav Dahle
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Mjøen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Hallvard Holdaas
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Linda Flaa-Johnsen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Anders Hartmann
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Trond Jenssen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Metabolic and Renal Research Group, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Helge Scott
- Department of Pathology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Finn P Reinholt
- Department of Pathology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
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15
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Vuiblet V, Fere M, Gobinet C, Birembaut P, Piot O, Rieu P. Renal Graft Fibrosis and Inflammation Quantification by an Automated Fourier-Transform Infrared Imaging Technique. J Am Soc Nephrol 2015; 27:2382-91. [PMID: 26683669 DOI: 10.1681/asn.2015050601] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 11/01/2015] [Indexed: 01/05/2023] Open
Abstract
Renal interstitial fibrosis and interstitial active inflammation are the main histologic features of renal allograft biopsy specimens. Fibrosis is currently assessed by semiquantitative subjective analysis, and color image analysis has been developed to improve the reliability and repeatability of this evaluation. However, these techniques fail to distinguish fibrosis from constitutive collagen or active inflammation. We developed an automatic, reproducible Fourier-transform infrared (FTIR) imaging-based technique for simultaneous quantification of fibrosis and inflammation in renal allograft biopsy specimens. We generated and validated a classification model using 49 renal biopsy specimens and subsequently tested the robustness of this classification algorithm on 166 renal grafts. Finally, we explored the clinical relevance of fibrosis quantification using FTIR imaging by comparing results with renal function at 3 months after transplantation (M3) and the variation of renal function between M3 and M12. We showed excellent robustness for fibrosis and inflammation classification, with >90% of renal biopsy specimens adequately classified by FTIR imaging. Finally, fibrosis quantification by FTIR imaging correlated with renal function at M3, and the variation in fibrosis between M3 and M12 correlated well with the variation in renal function over the same period. This study shows that FTIR-based analysis of renal graft biopsy specimens is a reproducible and reliable label-free technique for quantifying fibrosis and active inflammation. This technique seems to be more relevant than digital image analysis and promising for both research studies and routine clinical practice.
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Affiliation(s)
- Vincent Vuiblet
- Matrice Extracellulaire et Dynamique Cellulaire Unit, Centre National pour la Recherche Scientifique, Unité Mixte de Recherche 7369, and Nephrology and Renal Transplantation Department and Biopathology Laboratory, Centre Hospitalier et Universitaire de Reims, Reims, France
| | - Michael Fere
- Matrice Extracellulaire et Dynamique Cellulaire Unit, Centre National pour la Recherche Scientifique, Unité Mixte de Recherche 7369, and
| | - Cyril Gobinet
- Matrice Extracellulaire et Dynamique Cellulaire Unit, Centre National pour la Recherche Scientifique, Unité Mixte de Recherche 7369, and
| | - Philippe Birembaut
- Biopathology Laboratory, Centre Hospitalier et Universitaire de Reims, Reims, France
| | - Olivier Piot
- Matrice Extracellulaire et Dynamique Cellulaire Unit, Centre National pour la Recherche Scientifique, Unité Mixte de Recherche 7369, and Cellular and Tissular Imaging Platform, Université de Reims Champagne-Ardenne, Reims, France; and
| | - Philippe Rieu
- Matrice Extracellulaire et Dynamique Cellulaire Unit, Centre National pour la Recherche Scientifique, Unité Mixte de Recherche 7369, and Nephrology and Renal Transplantation Department and
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16
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Ecotière L, Thierry A, Debiais-Delpech C, Chevret S, Javaugue V, Desport E, Belmouaz S, Quellard N, Kaaki S, Goujon JM, Fermand JP, Touchard G, Bridoux F. Prognostic value of kidney biopsy in myeloma cast nephropathy: a retrospective study of 70 patients. Nephrol Dial Transplant 2015; 31:64-72. [PMID: 26289418 DOI: 10.1093/ndt/gfv283] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/25/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Light chain myeloma cast nephropathy (MCN) is the major cause of renal failure in multiple myeloma and strongly impacts patient survival. The role of kidney biopsy in the management of MCN is unclear. METHODS Renal pathological findings were retrospectively studied in 70 patients with multiple myeloma and MCN. Patients were categorized according to the achievement or not of renal response, as defined by estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m(2) and/or dialysis independence at 3 months. RESULTS Thirty-two patients (46%) achieved a renal response. In the whole study population, the following parameters differed significantly between patients with and without renal response, respectively: baseline median eGFR (13.3 versus 9.3 mL/min/1.73 m(2), P = 0.017), Acute Kidney Injury Network Stage 3 (68.8 versus 92.1%, P = 0.019), haematological response rate (94 versus 34%, P < 0.0001), median percentage of free light chain (FLC) reduction at Day 21 (92 versus 24%, P = 0.006) and median number of casts/10 fields (14 versus 25, P = 0.005). The extent of interstitial fibrosis and tubular atrophy was similar. In multivariate analysis, only FLC reduction at Day 21 was significantly associated with renal response. However, when considering only the subgroup of haematological responders, both median number of casts [odds ratio (OR) = 0.93, 95% confidence interval (95% CI): 0.88-0.98, P = 0.01] and extent of tubular atrophy (OR = 0.03, 95% CI: 0.00-0.52, P = 0.02) were independent predictors of renal response. CONCLUSIONS In MCN, the presence of numerous casts and diffuse tubular atrophy is associated with poor renal prognosis. These data suggest that additional strategies to reduce FLC burden should be considered in patients with extensive cast formation.
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Affiliation(s)
- Laure Ecotière
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Antoine Thierry
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | | | - Sylvie Chevret
- Department of Biostatistics, Saint Louis University Hospital, Paris, France
| | - Vincent Javaugue
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Estelle Desport
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Simohamed Belmouaz
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Nathalie Quellard
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
| | - Sihem Kaaki
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
| | - Jean Michel Goujon
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
| | - Jean-Paul Fermand
- Department of Hematology and Clinical Immunology, Saint Louis University Hospital, Paris, France
| | - Guy Touchard
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Frank Bridoux
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
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Chapal M, Foucher Y, Marguerite M, Neau K, Papuchon E, Daguin P, Morélon E, Mourad G, Cassuto E, Ladrière M, Legendre C, Giral M. PREventing Delayed Graft Function by Driving Immunosuppressive InduCtion Treatment (PREDICT-DGF): study protocol for a randomized controlled trial. Trials 2015; 16:282. [PMID: 26099226 PMCID: PMC4477597 DOI: 10.1186/s13063-015-0807-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 06/11/2015] [Indexed: 11/17/2022] Open
Abstract
Background In kidney transplantation, the use of Anti-Thymocyte Globulins (ATG) as induction therapy has been described as a possible treatment for reducing the prevalence of Delayed Graft Function (DGF). ATG possesses pharmaceutical proprieties that could help control the lesions caused by ischemia reperfusion injury. However, other studies have questioned this potential protective effect. We hypothesized that the benefits related to ATG for reducing DGF prevalence may be higher and more consistently recognized if only patients with high DGF risk are considered. We recently proposed a scoring system entitled DGFS (Delayed Graft Function Score) for such stratification of kidney transplant recipients according to their risk of DGF. Using the DGFS calculation, we aim to determine whether a short course of ATG can decrease the incidence of DGF in comparison with Basiliximab in kidney transplant recipients with low immunological risk but high DGF risk. Methods We conduct a phase IV, open label, randomized, multicentric and prospective study, to compare ATG in parallel with a control group treated by Basiliximab. The 1:1 randomized allocation of patients between groups is stratified on the clinical center, and on the hypothermic machine-perfusion device. We aimed to include a total of 384 patients to achieve a statistical power at 0.80. The study was initiated at the Nantes University hospital in July 2014, with data collection continuing until April 2018, and publication of the results proposed for 2019. Discussion The main expected benefits of this study are i) the reduction of unjustified ATG over-prescriptions associated with serious adverse events, ii) the reduction of chance losses related to ATG under-prescription, iii) the decrease in the incidence of DGF which was described as a risk factor of graft failure and patient death, and iv) the reduction in hospitalization duration and number of post transplantation dialysis sessions, both being associated with reduced medical costs. In conclusion, the current study is innovative by proposing a more efficient and personalized induction therapy. Trial registration The study was registered in the Clinical Trials Registry (#NCT02056938, February 5, 2014), and in the European Clinical Trials Database (EudraCT #2014-000332-42, January 30, 2014).
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Affiliation(s)
- Marion Chapal
- ITUN and Inserm U1064, Nantes University, 30 Boulevard Jean Monnet, Nantes, 44035, France.
| | - Yohann Foucher
- ITUN and Inserm U1064, Nantes University, 30 Boulevard Jean Monnet, Nantes, 44035, France. .,SPHERE (EA4275), Nantes University, Nantes, France. .,Délégation à la recherche clinique et à l'innovation, CHU Nantes, Nantes, France.
| | - Monique Marguerite
- Délégation à la recherche clinique et à l'innovation, CHU Nantes, Nantes, France.
| | - Karine Neau
- Délégation à la recherche clinique et à l'innovation, CHU Nantes, Nantes, France.
| | - Emmanuelle Papuchon
- ITUN and Inserm U1064, Nantes University, 30 Boulevard Jean Monnet, Nantes, 44035, France.
| | - Pascal Daguin
- ITUN and Inserm U1064, Nantes University, 30 Boulevard Jean Monnet, Nantes, 44035, France.
| | - Emmanuel Morélon
- Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France.
| | - Georges Mourad
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Lapeyronie and Université Montpellier I, Montpellier, France.
| | | | - Marc Ladrière
- Service de Transplantation Rénale, CHU Brabois, Nancy, France.
| | - Christophe Legendre
- Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP and Universités Paris Descartes et Sorbonne Paris Cité, Paris, France.
| | - Magali Giral
- ITUN and Inserm U1064, Nantes University, 30 Boulevard Jean Monnet, Nantes, 44035, France. .,SPHERE (EA4275), Nantes University, Nantes, France. .,Centre d'Investigation Clinique en Biothérapie, Nantes University Hospital, Nantes, France. .,CENTAURE Fondation, Nantes, France.
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18
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Boor P, Floege J. Renal allograft fibrosis: biology and therapeutic targets. Am J Transplant 2015; 15:863-86. [PMID: 25691290 DOI: 10.1111/ajt.13180] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/30/2014] [Accepted: 12/19/2014] [Indexed: 01/25/2023]
Abstract
Renal tubulointerstitial fibrosis is the final common pathway of progressive renal diseases. In allografts, it is assessed with tubular atrophy as interstitial fibrosis/tubular atrophy (IF/TA). IF/TA occurs in about 40% of kidney allografts at 3-6 months after transplantation, increasing to 65% at 2 years. The origin of renal fibrosis in the allograft is complex and includes donor-related factors, in particular in case of expanded criteria donors, ischemia-reperfusion injury, immune-mediated damage, recurrence of underlying diseases, hypertensive damage, nephrotoxicity of immunosuppressants, recurrent graft infections, postrenal obstruction, etc. Based largely on studies in the non-transplant setting, there is a large body of literature on the role of different cell types, be it intrinsic to the kidney or bone marrow derived, in mediating renal fibrosis, and the number of mediator systems contributing to fibrotic changes is growing steadily. Here we review the most important cellular processes and mediators involved in the progress of renal fibrosis, with a focus on the allograft situation, and discuss some of the challenges in translating experimental insights into clinical trials, in particular fibrosis biomarkers or imaging modalities.
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Affiliation(s)
- P Boor
- Division of Nephrology and Clinical Immunology, RWTH University of Aachen, Aachen, Germany; Department of Pathology, RWTH University of Aachen, Aachen, Germany; Institute of Molecular Biomedicine, Bratislava, Slovakia
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Abstract
Interstitial fibrosis is a hallmark structural correlate of progressive and chronic kidney disease. There remain many uncertainties about how to best measure interstitial fibrosis both in research settings and in evaluations of renal biopsies performed for management of individual patients. Areas of uncertainty include determination of the composition of the matrix in a fibrotic parenchyma, the definition of how the interstitium is involved by fibrosing injuries, the choice of histologic stains for evaluation of renal fibrosis, and the reproducibility and robustness of measures currently employed by pathologists, both with and without the assistance of computerized imaging and assessments. In this review, we address some of these issues while citing the key studies that illustrate these difficulties. We point to future approaches that may allow a more accurate and meaningful assessment of renal interstitial fibrosis.
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Farris AB, Chan S, Climenhaga J, Adam B, Bellamy COC, Serón D, Colvin RB, Reeve J, Mengel M. Banff fibrosis study: multicenter visual assessment and computerized analysis of interstitial fibrosis in kidney biopsies. Am J Transplant 2014; 14:897-907. [PMID: 24712330 DOI: 10.1111/ajt.12641] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 12/24/2013] [Accepted: 12/26/2013] [Indexed: 01/25/2023]
Abstract
Increasing interstitial fibrosis (IF) in native and kidney transplant biopsies is associated with functional decline and serves as a clinical trial end point. A Banff 2009 Conference survey revealed a range in IF assessment practices. Observers from multiple centers were asked to assess 30 renal biopsies with a range of IF and quantitate IF using two approaches on trichrome, Periodic acid-Schiff (PAS) and computer-assisted quantification of collagen III immunohistochemistry (C-IHC) slides, as well as assessing percent of cortical tubular atrophy% (TA%) and Banff total cortical inflammation score (ti-score). C-IHC using whole slide scans was performed. C-IHC assessment showed a higher correlation with organ function (r = -0.48) than did visual assessments (r = -0.32--0.42); computerized and visual C-IHC assessment also correlated (r = 0.64-0.66). Visual assessment of trichrome and C-IHC showed better correlations with organ function and C-IHC, than PAS, TA% and ti-score. However, visual assessment of IF, independent of approach, was variable among observers, and differences in correlations with organ function were not statistically significant among C-IHC image analysis and visual assessment methods. C-IHC image analysis correlated among three centers (r > 0.90, p < 0.0001, between all centers). Given the difficulty of visual IF assessment standardization, C-IHC image could potentially accomplish standardized IF assessment in multicenter settings.
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Affiliation(s)
- A B Farris
- Department of Pathology, Emory University, Atlanta, GA
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Pallet N, Chauvet S, Chassé JF, Vincent M, Avillach P, Levi C, Meas-Yedid V, Olivo-Marin JC, Nga-Matsogo D, Beaune P, Thervet E, Karras A. Urinary retinol binding protein is a marker of the extent of interstitial kidney fibrosis. PLoS One 2014; 9:e84708. [PMID: 24416268 PMCID: PMC3885590 DOI: 10.1371/journal.pone.0084708] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/18/2013] [Indexed: 11/19/2022] Open
Abstract
Currently, a non-invasive method to estimate the degree of interstitial fibrosis (IF) in chronic kidney disease is not available in routine. The aim of our study was to evaluate the diagnostic performance of the measurement of urinary low molecular weight (LMW) protein concentrations as a method to determine the extent of IF. The urines specimen from 162 consecutive patients who underwent renal biopsy were used in the analysis. Numerical quantification software based on the colorimetric analysis of fibrous areas was used to assess the percentage IF. Total proteinuria, albuminuria, and the urinary levels of retinol binding protein (RBP), alpha1-microglobulin (α1MG), beta 2-microglobulin (β2MG), transferrin, and IgG immunoglobulins were measured. There was a significant correlation between the degree of IF and the RBP/creatinine (creat) ratio (R2: 0.11, p<0.0001). IF was associated to a lesser extent with urinary β2MG and α1MG; however, there was no association with total proteinuria or high molecular weight (HMW) proteinuria. The correlation between IF and RBP/creat remained significant after adjustment to the estimated glomerular filtration rate, age, body mass index, α1MG, and β2MG. The specificity of the test for diagnosing a fibrosis score of >25% of the parenchyma was 95% when using a threshold of 20 mg/g creat. In conclusion, RBP appears to be a quantitative and non-invasive marker for the independent prediction of the extent of kidney IF. Because methods for the measurement of urinary RBP are available in most clinical chemistry departments, RBP measurement is appealing for implementation in the routine care of patients with chronic kidney disease.
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Affiliation(s)
- Nicolas Pallet
- INSERM U775, Centre Universitaire des Saints Pères, Paris, France
- Service de Biochimie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
- * E-mail:
| | - Sophie Chauvet
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
| | - Jean-François Chassé
- INSERM U775, Centre Universitaire des Saints Pères, Paris, France
- Université Paris Descartes, Paris, France
| | - Marc Vincent
- INSERM U775, Centre Universitaire des Saints Pères, Paris, France
| | - Paul Avillach
- Departement d’informatique médicale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
| | - Charlene Levi
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
| | | | | | - Diane Nga-Matsogo
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Beaune
- INSERM U775, Centre Universitaire des Saints Pères, Paris, France
- Service de Biochimie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
| | - Eric Thervet
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
| | - Alexandre Karras
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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22
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Hadlock TA, Kim SW, Weinberg JS, Knox CJ, Hohman MH, Heaton JT. Quantitative analysis of muscle histologic method in rodent facial nerve injury. JAMA FACIAL PLAST SU 2013; 15:141-6. [PMID: 23329158 DOI: 10.1001/jamafacial.2013.430] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To describe denervation features of facial musculature following facial nerve injury in a rodent model. METHODS Six Wistar-Hannover rats underwent unilateral transection and immediate repair of the facial nerve. After 8 weeks, muscular bundles consisting of dilator naris and levator labii superioris from both sides were analyzed for mean muscle cell diameter and the percentage of muscle cell cross-sectional area using image processing software. The atrophic features of facial muscles were quantified and compared with the contralateral, healthy side of the face. RESULTS Weekly postoperative whisking assessment demonstrated the anticipated course of recovery. We observed significant differences between the normal side and the manipulated side, respectively, in the percentage of muscle specimen cross-sectional area attributable to muscle cell profiles (57% vs 29%; P = .006) and total fiber counts (1346 vs 794; P = .02). The mean cross-sectional area of individual muscle fibers was higher on the normal side (1129 vs 928 μm2; P = .39); however, this difference was statistically nonsignificant. CONCLUSION The objective, quantitative measures of muscle microstructure used in this report provide a valuable point of comparison for whisking function and electrophysiologic measures and can be used in future studies to assess muscle atrophic features associated with facial nerve injury and repair techniques.
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Affiliation(s)
- Tessa A Hadlock
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA.
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23
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Hanf W, Petruzzo P, Meas-Yedid V, Berthiller J, Martin X, Morelon E, Badet L, Codas R. Dual kidney transplantation from uncontrolled deceased donors after cardiac arrest: a possible option. Int J Urol 2013; 21:204-6. [PMID: 23944687 DOI: 10.1111/iju.12237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 06/28/2013] [Indexed: 11/28/2022]
Abstract
Organ shortage is a major problem in organ transplantation. For this reason, transplantation teams have found it necessary to revisit their organ acceptance criteria. Uncontrolled deceased donors after cardiac arrest could increase the donor pool by 20%, but at the same time there is a greater risk of delayed graft function and primary non-function. Dual kidney transplantation is an option when single kidney transplantation cannot be carried out because of lack of organ quality. We report for the first time our four first dual kidney transplantation from uncontrolled deceased donors after cardiac arrest with a follow up longer than 1 year. We described graft outcomes until 5 years, and histology at 3 and 12 months after transplantation. All organs were machine perfused in order to assess their quality leading to a single kidney transplantation or dual kidney transplantation decision. After 1 year of follow up, all grafts were functional with a mean estimated glomerular filtration rate of 44.5 ± 3.3 mL/min/1.73 m(2), and a mean inulin clearance of 43.7 ± 13.6 mL/mn/1.73 m(2). These findings suggest that dual kidney transplantation can represent a viable option for kidneys unsuitable for single kidney transplantation without increasing the rate of surgical complications. Successful transplantation is linked to histological, biological and donor clinical criteria, as well as perfusion parameters.
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Affiliation(s)
- William Hanf
- Department of Nephrology, Transplantation and Clinical Immunology, Edouard Herriot Hospital, Lyon, France
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24
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Kamar N, Maaroufi C, Guilbeau-Frugier C, Servais A, Meas-Yedid V, Tack I, Thervet E, Cointault O, Esposito L, Guitard J, Lavayssière L, Panterne C, Muscari F, Bureau C, Rostaing L. Do kidney histology lesions predict long-term kidney function after liver transplantation? Clin Transplant 2012; 26:927-34. [PMID: 22774805 DOI: 10.1111/j.1399-0012.2012.01682.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2012] [Indexed: 11/29/2022]
Abstract
Histological renal lesions observed after liver transplantation are complex, multifactorial, and interrelated. The aims of this study were to determine whether kidney lesions observed at five yr after liver transplantation can predict long-term kidney function. Ninety-nine liver transplant patients receiving calcineurin inhibitor (CNI)-based immunosuppression, who had undergone a kidney biopsy at 60±48 months post-transplant, were included in this follow-up study. Kidney biopsies were scored according to the Banff classification. Estimated glomerular filtration rate (eGFR) was assessed at last follow-up, that is, 109±48 months after liver transplantation. eGFR decreased from 92±33 mL/min at transplantation to 63±19 mL/min after six months, to 57±17 mL/min at the kidney biopsy, to 54±24 mL/min at last follow-up (p<0.0001). At last follow-up, only three patients required renal replacement therapy. After the kidney biopsy, 13 patients were converted from CNIs to mammalian target of rapamycin inhibitors, but no significant improvement in eGFR was observed after conversion. Elevated eGFR at six months post-transplant and a lower fibrous intimal thickening score (cv) observed at five yr post-transplant were the two independent predictive factors for eGFR≥60 mL/min at nine yr post-transplant. Long-term kidney function seems to be predicted by the kidney vascular lesions.
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Affiliation(s)
- Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Université Paul Sabatier, Toulouse, France.
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25
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Hanf W, Codas R, Meas-Yedid V, Berthiller J, Buron F, Chauvet C, Brunet M, Giroud A, McGregor BC, Olivo-Marin JC, Hadj-Aissa A, Faure A, Petruzzo P, Martin X, Badet L, Morelon E. Kidney graft outcome and quality (after transplantation) from uncontrolled deceased donors after cardiac arrest. Am J Transplant 2012; 12:1541-50. [PMID: 22390302 DOI: 10.1111/j.1600-6143.2011.03983.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The use of uncontrolled deceased donors after cardiac arrest (uDDCA) has been developed in France to compensate for organ shortage. The quality of these kidneys remains unclear. We analyzed kidney graft function and histology from 27 uDDCA and compared them with kidneys from 30 extended criteria donors (ECD) and from 24 simultaneous pancreas kidney (SPK) donors as a control group of optimal deceased donors. Kidneys from ECD and SPK donors were preserved by static cold storage while kidneys from uDDCA were preserved by pulsatile perfusion. The uDDCA graft function at 3 years posttransplantation (estimated with MDRD and measured with inulin clearance) did not differ from that of the ECD group (eGFR 44.1 vs. 37.4 mL/min/1.73 m(2) , p = 0.13; mGFR 44.6 vs. 36.1 mL/min/1.73 m(2) , p = 0.07 in the uDDCA and ECD groups, respectively). The histological assessment of 3-month and 1-year protocol biopsies did not show differences for interstitial lesions between the uDDCA and ECD grafts (IF score at M3 was 30 vs. 28% and at M12 36 vs. 33%, p = NS). In conclusion, the results at 3 years with carefully selected and machine-perfused uDDCA kidneys have been comparable to ECD kidneys and encourage continuation of this program and development of similar programs.
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Affiliation(s)
- W Hanf
- Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.
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26
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Abstract
PURPOSE OF REVIEW Tubulointerstitial injury in the kidney is complex, involving a number of independent and overlapping cellular and molecular pathways, with renal interstitial fibrosis and tubular atrophy (IFTA) as the final common pathway. Furthermore, there are multiple ways to assess IFTA. RECENT FINDINGS Cells involved include tubular epithelial cells, fibroblasts, fibrocytes, myofibroblasts, monocyte/macrophages, and mast cells with complex and still incompletely characterized cell-molecular interactions. Molecular mediators involved are numerous and involve pathways such as transforming growth factor (TGF)-β, bone morphogenic protein (BMP), platelet-derived growth factor (PDGF), and hepatocyte growth factor (HGF). Recent genomic approaches have shed insight into some of these cellular and molecular pathways. Pathologic evaluation of IFTA is central in assessing the severity of chronic disease; however, there are a variety of methods used to assess IFTA. Most assessment of IFTA relies on pathologist assessment of special stains such as trichrome, Sirius Red, and collagen III immunohistochemistry. Visual pathologist assessment can be prone to intra and interobserver variability, but some methods employ computerized morphometery, without a clear consensus as to the best method. SUMMARY IFTA results from on orchestration of cell types and molecular pathways. Opinions vary on the optimal qualitative and quantitative assessment of IFTA.
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Affiliation(s)
- Alton B Farris
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia 30322, USA.
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27
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Klapczynski M, Gagne GD, Morgan SJ, Larson KJ, Leroy BE, Blomme EA, Cox BF, Shek EW. Computer-assisted imaging algorithms facilitate histomorphometric quantification of kidney damage in rodent renal failure models. J Pathol Inform 2012; 3:20. [PMID: 22616032 PMCID: PMC3352620 DOI: 10.4103/2153-3539.95456] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 04/04/2012] [Indexed: 02/01/2023] Open
Abstract
Introduction: Surgical 5/6 nephrectomy and adenine-induced kidney failure in rats are frequently used models of progressive renal failure. In both models, rats develop significant morphological changes in the kidneys and quantification of these changes can be used to measure the efficacy of prophylactic or therapeutic approaches. In this study, the Aperio Genie Pattern Recognition technology, along with the Positive Pixel Count, Nuclear and Rare Event algorithms were used to quantify histological changes in both rat renal failure models. Methods: Analysis was performed on digitized slides of whole kidney sagittal sections stained with either hematoxylin and eosin or immunohistochemistry with an anti-nestin antibody to identify glomeruli, regenerating tubular epithelium, and tubulointerstitial myofibroblasts. An anti-polymorphonuclear neutrophil (PMN) antibody was also used to investigate neutrophil tissue infiltration. Results: Image analysis allowed for rapid and accurate quantification of relevant histopathologic changes such as increased cellularity and expansion of glomeruli, renal tubular dilatation, and degeneration, tissue inflammation, and mineral aggregation. The algorithms provided reliable and consistent results in both control and experimental groups and presented a quantifiable degree of damage associated with each model. Conclusion: These algorithms represent useful tools for the uniform and reproducible characterization of common histomorphologic features of renal injury in rats.
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Affiliation(s)
- Marcin Klapczynski
- Investigative Toxicology and Pathology, Abbott Laboratories, 100 Abbott Park Rd, Abbott Park, IL 60064, USA
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