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: 3] [Impact Index Per Article: 0.8] [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
|
Richterman A, Sawinski D, Reese PP, Lee DH, Clauss H, Hasz RD, Thomasson A, Goldberg DS, Abt PL, Forde KA, Bloom RD, Doll SL, Brady KA, Blumberg EA. An Assessment of HIV-Infected Patients Dying in Care for Deceased Organ Donation in a United States Urban Center. Am J Transplant 2015; 15:2105-16. [PMID: 25976241 DOI: 10.1111/ajt.13308] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/05/2015] [Accepted: 03/05/2015] [Indexed: 01/25/2023]
Abstract
Organ transplantation is an acceptable option for human immunodeficiency virus (HIV)-infected patients with end-stage kidney or liver disease. With worse outcomes on the waitlist, HIV-infected patients may actually be disproportionately affected by the organ shortage in the United States. One potential solution is the use of HIV-infected deceased donors (HIVDD), recently legalized by the HIV Organ Policy Equity (HOPE) Act. This is the first analysis of patient-specific data from potential HIVDD, retrospectively examining charts of HIV-infected patients dying in care at six HIV clinics in Philadelphia, Pennsylvania from January 1, 2009 to June 30, 2014. Our data suggest that there are four to five potential HIVDD dying in Philadelphia annually who might yield two to three kidneys and three to five livers for transplant. Extrapolated nationally, this would approximate 356 potential HIVDD yielding 192 kidneys and 247 livers annually. However, several donor risk indices raise concerns about the quality of kidneys that could be recovered from HIVDD as a result of older donor age and comorbidities. On the other hand, livers from these potential HIVDD are of similar quality to HIV-negative donors dying locally, although there is a high prevalence of positive hepatitis C antibody.
Collapse
Affiliation(s)
- A Richterman
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - D Sawinski
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - P P Reese
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - D H Lee
- Department of Medicine, Drexel University, Philadelphia, PA
| | - H Clauss
- Department of Medicine, Temple University, Philadelphia, PA
| | - R D Hasz
- Gift of Life Donor Program, Philadelphia, PA
| | - A Thomasson
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - D S Goldberg
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - P L Abt
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - K A Forde
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - R D Bloom
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - S L Doll
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - K A Brady
- Philadelphia Department of Public Health, Philadelphia, PA
| | - E A Blumberg
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|