1
|
Ellingsen AR, Jørgensen KA, Østerby R, Petersen SE, Juul S, Marcussen N, Nyengaard JR. Human kidney graft survival correlates with structural parameters in baseline biopsies: a quantitative observational cohort study with more than 14 years' follow-up. Virchows Arch 2020; 478:659-668. [PMID: 32986179 DOI: 10.1007/s00428-020-02924-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 01/05/2023]
Abstract
This prospective cohort study evaluates associations between structural and ultrastructural parameters in baseline biopsies from human kidney transplants and long-term graft survival after more than 14 years' follow-up. Baseline kidney graft biopsies were obtained prospectively from 54 consecutive patients receiving a kidney transplant at a single institution. Quantitative measurements were performed on the baseline biopsies by computer-assisted light microscopy and electron microscopy. Stereology-based techniques estimated the fraction of interstitial tissue, the volume of glomeruli, mesangial fraction, and basement membrane thickness of glomerular capillaries. The fraction of occluded glomeruli and scores according to the Banff classification were achieved. Kidney graft survival was analyzed by Kaplan-Meier estimates and Cox regression. Association to long-term kidney function was also analyzed. The long-term surviving kidney transplants were characterized at implantation by less arteriolar hyaline thickening (P < 0.001) and less interstitial fibrosis (P = 0.001), as well as a lower fraction of occluded glomeruli (P = 0.004) and lower glomerular volume (P = 0.03). At the latest follow-up, eGFR was decreased by 12 ml/min/1.73 m2 per unit increase in the score for arteriolar hyalinosis at implantation (P = 0.02), and eGFR was decreased by 19 ml/min/1.73 m2 per 106 μm3 increase in glomerular volume at baseline (P = 0.03). The unbiased Cavalieri estimate of glomerular volume and the ultrastructural parameters are the first to be evaluated in a cohort study with prospective follow-up for more than 14 years. The study shows that baseline biopsies from human kidney grafts contain extraordinary long-term prognostic information, and it highlights the importance of these intrinsic graft factors.
Collapse
Affiliation(s)
- Anne R Ellingsen
- Electron Microscopy Laboratory, Aarhus University Hospital, 8200, Aarhus N, Denmark. .,Department of Pathology, Aarhus University Hospital, 8200, Aarhus N, Denmark. .,Department of Clinical Pathology, Odense University Hospital, 5000, Odense C, Denmark. .,Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, 8200, Aarhus N, Denmark.
| | - Kaj A Jørgensen
- Department of Nephrology, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Ruth Østerby
- Electron Microscopy Laboratory, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Steffen E Petersen
- Department of Urology, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Svend Juul
- Department of Public Health, Section for Epidemiology, Aarhus University, 8000, Aarhus C, Denmark
| | - Niels Marcussen
- Department of Clinical Pathology, Odense University Hospital, 5000, Odense C, Denmark
| | - Jens R Nyengaard
- Electron Microscopy Laboratory, Aarhus University Hospital, 8200, Aarhus N, Denmark.,Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, 8200, Aarhus N, Denmark.,Centre for Stochastic Geometry and Advanced Bioimaging, Aarhus University, 8000, Aarhus C, Denmark
| |
Collapse
|
2
|
Zamani M, Skagen K, Scott H, Lindberg B, Russell D, Skjelland M. Carotid Plaque Neovascularization Detected With Superb Microvascular Imaging Ultrasound Without Using Contrast Media. Stroke 2019; 50:3121-3127. [PMID: 31510899 DOI: 10.1161/strokeaha.119.025496] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background and Purpose- A significant proportion of ischemic strokes are caused by emboli from unstable carotid artery plaques with intraplaque neovascularization (IPN) as a key feature of plaque instability. IPN is not detectable with conventional Doppler ultrasound. Contrast-enhanced ultrasound (CEUS) can visualize IPN, but its use is limited in clinical practice because it requires an intravenous injection of contrast. Superb microvascular imaging (SMI) without contrast uses an algorithm to remove clutter and motion wall artifacts while preserving low-velocity blood flow signals, enabling visualization of IPN. Our aim was to assess the feasibility of SMI for the detection of IPN. Methods- Thirty-one patients with >50% carotid stenosis were included: 22 patients were symptomatic and 9 asymptomatic. All patients underwent conventional carotid ultrasound, CEUS, SMI, and blood tests. CEUS and SMI findings were compared and correlated to histological plaque assessments after endarterectomy. Results- There was significant positive correlation between an IPN visual 5-level classification of SMI and a semiquantitative analysis of CEUS (P<0.001, r=0.911). Plaques with higher SMI grades had higher numbers of neovessels quantified at histology (P=0.041, r=0.460). Hypoechoic plaques had higher grades of IPN on both CEUS and SMI (P<0.001). Higher visual IPN counts on SMI were associated with (1) increased areas of inflammation (P=0.043, r=0.457), (2) combined rank scores of granulation tissue, inflammation and lipids (P=0.02, r=0.494) at histology, and (3) higher peak-intensity values on quantitative CEUS (P=0.042, r=0.514). Conclusions- SMI ultrasound can detect neovascularization with accuracy comparable to CEUS, suggesting SMI to be a promising noninvasive alternative to CEUS for the assessment of carotid plaque stability.
Collapse
Affiliation(s)
- Mahtab Zamani
- From the Department of Neurology (M.Z., K.S., D.R., M.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| | - Karolina Skagen
- From the Department of Neurology (M.Z., K.S., D.R., M.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| | - Helge Scott
- Department of Pathology (H.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| | - Beate Lindberg
- Department of Cardiothoracic Surgery (B.L.), Oslo University Hospital, Rikshospitalet, Norway
| | - David Russell
- From the Department of Neurology (M.Z., K.S., D.R., M.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| | - Mona Skjelland
- From the Department of Neurology (M.Z., K.S., D.R., M.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| |
Collapse
|
3
|
Dupont L, Eide IA, Hartmann A, Christensen JH, Åsberg A, Jenssen T, Krarup H, Svensson M. Haptoglobin 2-2 Genotype, Patient, and Graft Survival in Renal Transplant Recipients. Prog Transplant 2017; 27:386-391. [PMID: 29187131 DOI: 10.1177/1526924817732020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in renal transplant recipients. An association between haptoglobin genotype 2-2 and cardiovascular disease has been found in patients with diabetes mellitus and liver transplant recipients. To date, the role of haptoglobin genotype after renal transplantation has not been studied. METHODS In this single-center retrospective cohort study of 1975 adult Norwegian transplant recipients, who underwent transplantation between 1999 and 2011, we estimated the risk of all-cause and cardiovascular mortality and overall and death-censored graft loss for patients with haptoglobin genotype 2-2 compared to genotype 2-1 or 1-1, after adjustment for confounders and competing risks. RESULTS We found no associations between haptoglobin genotype 2-2 and cardiovascular mortality (subdistributional hazard ratio 1.08, 95% confidence interval 0.78-1.49; P = .63). We also failed to detect any association between haptoglobin 2-2 genotype and all-cause mortality, overall graft loss, and death-censored graft loss. Similar results were found in the subpopulation of transplant recipients with diabetes. CONCLUSION In this large cohort of kidney transplant recipients, we could not demonstrate any association between haptoglobin 2-2 genotype and patient or graft survival after renal transplantation.
Collapse
Affiliation(s)
- Laust Dupont
- 1 Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark
| | - Ivar Anders Eide
- 2 Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,3 Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Anders Hartmann
- 2 Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,4 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jeppe Hagstrup Christensen
- 5 Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark.,6 Centre for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark
| | - Anders Åsberg
- 2 Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,7 The Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,8 Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Trond Jenssen
- 2 Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,9 Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Henrik Krarup
- 10 Section of Molecular Diagnostics, Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - My Svensson
- 11 Department of Nephrology, Oslo University Hospital, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
4
|
Eide IA, Dörje C, Svensson M, Jenssen T, Hammarstrøm C, Scott H, Bjerve KS, Christensen JH, Schmidt EB, Hartmann A, Åsberg A, Reisæter AV, Reinholt FP. Development of Kidney Transplant Fibrosis Is Inversely Associated With Plasma Marine Fatty Acid Level. J Ren Nutr 2017; 28:118-124. [PMID: 29146138 DOI: 10.1053/j.jrn.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 09/09/2017] [Accepted: 09/09/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE(S) We assessed associations between plasma levels of polyunsaturated fatty acids (PUFAs) and degree of inflammation and interstitial fibrosis in transplanted kidneys. DESIGN The design of the study was single center cohort study. SUBJECTS A study population of 156 patients who received a kidney transplant at Oslo University Hospital during 2010. MAIN OUTCOME MEASURE Kidney transplant biopsies were obtained at 2 months and 1 year after transplantation. Degree of inflammation and interstitial fibrosis in the cortex of transplanted kidneys were estimated semi-quantitatively. Plasma phospholipid fatty acids levels were measured in a stable phase 2 months posttransplant. We used multivariate linear regression to assess associations between plasma levels of PUFAs and degree of inflammation and interstitial fibrosis at 2 months and 1 year postoperatively and change in degree of interstitial fibrosis during the first year after transplantation, adjusting for inflammation and fibrosis risk factors. RESULTS Higher plasma marine n-3 PUFA levels were associated with less development of interstitial fibrosis in the kidney transplant (unstandardized β-coefficient -1.12, standardized β-coefficient -0.18, P = .03) during the first year after transplantation. Plasma levels of alpha linoleic acid, linoleic acid, and arachidonic acid were not associated with development of interstitial fibrosis. No associations were found between plasma levels of PUFAs and inflammation inside fibrotic areas or outside fibrotic areas in the kidney transplant at neither 2 months nor 1 year postoperatively. Linolenic acid levels in plasma were positively associated with change in renal function during the first year after transplantation. CONCLUSION The inverse association between plasma marine n-3 PUFA levels and development of interstitial fibrosis during the first year after kidney transplantation suggests that marine fatty acid consumption might halt progression of fibrosis.
Collapse
Affiliation(s)
- Ivar A Eide
- Department of Renal Medicine, Akershus University Hospital, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Christina Dörje
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - My Svensson
- Department of Renal Medicine, Akershus University Hospital, Oslo, Norway; Institute of Clinical Medicine, The University of Oslo, Oslo, Norway
| | - Trond Jenssen
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Clara Hammarstrøm
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Helge Scott
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kristian S Bjerve
- Department of Medical Biochemistry, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Erik B Schmidt
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anders Hartmann
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, The University of Oslo, Oslo, Norway
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway; The Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anna V Reisæter
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; The Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Finn P Reinholt
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| |
Collapse
|
5
|
Abstract
All causes of renal allograft injury, when severe and/or sustained, can result in chronic histological damage of which interstitial fibrosis and tubular atrophy are dominant features. Unless a specific disease process can be identified, what drives interstitial fibrosis and tubular atrophy progression in individual patients is often unclear. In general, clinicopathological factors known to predict and drive allograft fibrosis include graft quality, inflammation (whether "nonspecific" or related to a specific diagnosis), infections, such as polyomavirus-associated nephropathy, calcineurin inhibitors (CNI), and genetic factors. The incidence and severity of chronic histological damage have decreased substantially over the last 3 decades, but it is difficult to disentangle what effects individual innovations (eg, better matching and preservation techniques, lower CNI dosing, BK viremia screening) may have had. There is little evidence that CNI-sparing/minimization strategies, steroid minimization or renin-angiotensin-aldosterone system blockade result in better preservation of intermediate-term histology. Treatment of subclinical rejections has only proven beneficial to histological and functional outcome in studies in which the rate of subclinical rejection in the first 3 months was greater than 10% to 15%. Potential novel antifibrotic strategies include antagonists of transforming growth factor-β, connective tissue growth factor, several tyrosine kinase ligands (epidermal growth factor, platelet-derived growth factor, vascular endothelial growth factor), endothelin and inhibitors of chemotaxis. Although many of these drugs are mainly being developed and marketed for oncological indications and diseases, such as idiopathic pulmonary fibrosis, a number may hold promise in the treatment of diabetic nephropathy, which could eventually lead to applications in renal transplantation.
Collapse
Affiliation(s)
- Thomas Vanhove
- 1 Department of Microbiology and Immunology, KU Leuven-University of Leuven, Leuven, Belgium. 2 Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium. 3 Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | |
Collapse
|
6
|
Prognostic Value of Modified Banff Score in the Evolution of Renal Function. Transplant Proc 2016; 48:2903-2905. [PMID: 27932103 DOI: 10.1016/j.transproceed.2016.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/03/2016] [Accepted: 09/02/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Some lesions not included in the Banff classification, such as inflammation in the scarred areas and total inflammation, have been described to have prognostic value in the evaluation of graft biopsies. Our aim was to reassess kidney graft biopsies and study the impact of histopathologic lesions, both those graded in the Banff classification and those related to inflammation, on the graft function and evolution. METHODS We selected 20 biopsies exhibiting chronic pathology without a specific phenotype, and we reevaluated them with the use of a modified Banff score. RESULTS We found statistically significant association between the presence of total inflammation (P = .048; P = .038), the presence of inflammation in scared area (P = .037; P = .018), and creatinine at the time of renal biopsy and 1 year after the renal biopsy, respectively. CONCLUSIONS Our results suggest that the presence of both inflammation in the scarred areas and total inflammation are related to renal function at the time of the biopsy and to renal function 1 year after the biopsy.
Collapse
|