A Simple Clinico-Histopathological Composite Scoring System Is Highly Predictive of Graft Outcomes in Marginal Donors

Anglicheau, Dany; Loupy, Alexandre; Lefaucheur, Carmen; Pessione, Fabienne; Létourneau, Isabelle; Côté, Isabelle; Gaha, K.; Nôël, Laure-Hélène; Patey, Natacha; Droz, Dominique; Martinez, Frank; Zuber, Julien; Glotz, Denis; Thervet, Éric; Legendre, Christophe

doi:10.1111/j.1600-6143.2008.02394.x

Cited by 117 publications

(90 citation statements)

References 32 publications

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“…However, the values of the Remuzzi score that determine single or dual implantation were derived from a hypothetical evaluation of the minimum required nephron mass, and the precise cutoff points of the score are still debated and have yet to be validated clinically (20,21). Similarly, few studies have examined the relevance of the Remuzzi score to assessment of DCD kidneys, and it is possible that acute ischaemic injury related to donor instability during the 'agonal' or asystolic phases, which would not be apparent on time-zero biopsy, may have a greater impact on longterm DCD kidney outcomes than the presence of chronic baseline renal degenerative changes.…”

Section: Discussionmentioning

confidence: 99%

Baseline Donor Chronic Renal Injury Confers the Same Transplant Survival Disadvantage for DCD and DBD Kidneys

Kosmoliaptsis

Salji

Bardsley

et al. 2015

American Journal of Transplantation

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Histological assessment of baseline chronic kidney injury may discriminate kidneys that are suitable for transplantation, but has not been validated for appraisal of donation after circulatory death (DCD) kidneys. 'Time-zero' biopsies for 371 consecutive, solitary, deceased-donor kidneys transplanted at our center between 2006 and 2010 (65.5% DCD, 34.5% donation after brain death [DBD]) were reviewed and baseline chronic degenerative injury scored using Remuzzi's classification. High scores correlated with donor age and extended criteria donors (42% of donors), but the spectrum of scores was similar for DCD and DBD kidneys. Transplant outcomes for kidneys scoring from 0 to 4 were comparable (1 and 3 year graft survival 95% and 92%), but were much poorer for kidneys scoring !5, with 1 year graft survival only 73%, and 12.5% suffering primary nonfunction. Critically, high Remuzzi scores conferred the same survival disadvantage for DCD and DBD kidneys. On multi-variable regression analysis, time-zero biopsy score was the only independent predictor for graft survival, whereas one-year graft estimated glomerular filtration rate (eGFR) correlated with donor age and biopsy score. In conclusion, the relationship between severity of chronic kidney injury and transplant outcome is similar for DCD and DBD kidneys. Kidneys with Remuzzi scores of 4 can be implanted singly with acceptable results.

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Section: Discussionmentioning

confidence: 99%

Baseline Donor Chronic Renal Injury Confers the Same Transplant Survival Disadvantage for DCD and DBD Kidneys

Kosmoliaptsis

Salji

Bardsley

et al. 2015

American Journal of Transplantation

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“…Gjertson 29 and Ortiz et al 30 demonstrate the distinct influence of factors such as systolic and diastolic blood pressure, hyperlipidemia and glycemic control on both graft function and survival. With the inclusion of these factors a practical predictive model for five year follow-up may be possible but would require further study -Anglicheau et al 31 came to a similar conclusion using histopathological factors in marginal donors.…”

Section: Discussionmentioning

confidence: 66%

Factors affecting eGFR 5-year post-deceased donor renal transplant: analysis and predictive model

et al. 2015

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Aim: Long-term survival of renal allografts has improved over the last 20 years. However, less is known about current expectations for long-term allograft function as determined by estimated glomerular filtration rate (eGFR). The aim of this study was to investigate factors which affect graft function at 5 years' post-renal transplantation. The statistically significant factors were then used to construct a predictive model for expected eGFR at five years' post-transplant. Methods: We retrospectively reviewed all adult patients who received a renal transplant in the Republic of Ireland between 1990 and. Data collected included era of transplantation (1990-1994, 1995-1999, 2000-2004), donor and recipient age and gender, number of human leucocyte antigen mismatches, cold ischemia time (CIT), number of prior renal transplants, immunosuppressive regimen used and acute rejection episodes. Estimated GFR was calculated at 5 years after transplantation from patient data using the Modified Diet in Renal Disease (MDRD) equation. Consecutive sampling was used to divide the study population into two equal unbiased groups of 489 patients. The first group (derivation cohort) was used to construct a predictive model for eGFR five years' post-transplantation, the second (validation cohort) to test this model. Results: Nine hundred and seventy eight patients were analyzed. The median age at transplantation was 43 years (range 18-78) and 620 (63.4%) were male. One hundred and seventy five patients (17.9%) had received a prior renal transplant. Improved eGFR at five years' post-transplantation was associated with tacrolimus-based combination immunosuppression, younger donor age, male recipient, absence of cytomegalovirus disease and absence of acute rejection episodes as independently significant factors (p50.05). The predictive model developed using these factors showed good correlation between predicted and actual median eGFR at five years. The model explained 20% of eGFR variability. The validation model findings were consistent with the derivation model (21% variability of eGFR explained by model using same covariates on new data). Conclusion: The predictive model we have developed shows good correlation between predicted and actual median eGFR at five years' post-transplant. Applications of this model include comparison of current and future therapy options such as new immunosuppressive regimens.

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“…The best known classifications are from Remuzzi et al [25] and the Banff criteria [26], but there are others like Maryland Aggregate Pathology Index (MAPI) [7] and Chronic Allograft Damage Index (CADI) [27,28]. Still others are mixed clinical and histologic classifications such as the one proposed by Anglicheau et al [29]. However, there remain uncertainties about the best way to sample, process, and evaluate these biopsies.…”

Section: Discussionmentioning

confidence: 99%

Pretransplant Biopsy in Expanded Criteria Donors: Do We Really Need It?

Tavares-da-Silva¹,

Oliveira²,

Castelo³

et al. 2014

Transplantation Proceedings

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Introduction. Renal transplantation is the best treatment for end-stage renal disease, including when using expanded criteria donors (ECD) kidneys. However, these suboptimal kidneys should be evaluated rigorously to meet their usefulness. Opinions differ about the best way to evaluate them. Materials and Methods. We retrospectively reviewed kidneys from ECD harvested by a single academic institution between January 2008 and September 2013. Needle biopsies were performed at the time of the harvest when considered relevant by the transplant team. Two pathologists where responsible for their analysis; the Remuzzi classification has been used in all cases. Results. We evaluated 560 ECD kidneys. Biopsies were made in 197 (35.2%) organs, 20 of which were considered not usable and 36 good only for double transplantation. Sixty-three kidneys (11.3%) were discarded by the transplant team based on the biopsy result and clinical criteria. Donors who underwent a biopsy were older (P < .001) and had a worse glomerular filtration rate (GFR; P ¼ .001). Comparing donors approved and rejected by the biopsy, the rejected donors were heavier (P ¼ .003) and had a lower GFR (P ¼ .002). Cold ischemia time was longer for the biopsy group (P < .001). Regarding graft function, the biopsy overall score correlated with the transplant outcome in the short and long term. Separately, glomeruli and interstitium scores were correlated with recipient's GFR in the earlier periods (3 months; P ¼ .025 and .037), and the arteries and tubules correlated with GFR in the longer term (at 3 years P ¼ .004 and .010). Conclusion. The decision on the usability of ECD grafts is complex. At our center, we chose a mixed approach based on donor risk. Low-risk ECD do not require biopsy. In more complex situations, especially older donors or those with a lower GFR, prompted a pretransplant biopsy. The biopsy results proved to be useful as they relate to subsequent transplant outcomes, thereby allowing us to exclude grafts whose function would most probably be less than optimal.

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A Simple Clinico-Histopathological Composite Scoring System Is Highly Predictive of Graft Outcomes in Marginal Donors

Cited by 117 publications

References 32 publications

Baseline Donor Chronic Renal Injury Confers the Same Transplant Survival Disadvantage for DCD and DBD Kidneys

Baseline Donor Chronic Renal Injury Confers the Same Transplant Survival Disadvantage for DCD and DBD Kidneys

Factors affecting eGFR 5-year post-deceased donor renal transplant: analysis and predictive model

Pretransplant Biopsy in Expanded Criteria Donors: Do We Really Need It?

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