Confirmation of the Utility of Fine Needle Aspiration Biopsy of the Renal Allograft

Helderman, J. Harold; Hernández, J; Sagalowsky, Arthur I.; Dawidson, Ingemar; Glennie, J. S.; Womble, D.; Toto, Robert D.; Brinker, Karl R.; Hull, Alan R.

doi:10.1016/s0022-5347(17)40964-5

Cited by 6 publications

(11 citation statements)

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“…Nor was a preponderance of macrophages, a feature of severe, often irreversible, rejec tion [24], observed consistently in the cohort of patients who lost their allografts from uncontrollable rejection. The lower sensitivity of this technique in predominantly vascular and acute-on-chronic rejection is in agreement with the literature [35,36], but the low sensitivity and specificity of FNAB in the diagnosis of acute interstitial rejection observed in the present study falls far short of the 90% sensitivity reported from some centers [11,35,37], The failure to differentiate cortical from medullary aspirates [38], the slightly different scoring techniques [11,39], and the single nature o f the test as performed in the majority of patients in the present study are possible explanations. Serial aspirates performed in 9 patients as the rejection process advanced did not, however, improve sensitivity (table 3).…”

Section: Discussionsupporting

confidence: 93%

“…No complica tions were observed in the present study. 13.2% of the aspirates were inadequate due to a paucity of tubular cells comparable to that reported in the literature [11]. In our hands, when used as a single test, it was, however, rela tively insensitive and nonspecific in the diagnosis of acute rejection, especially vascular or when superimposed upon chronic rejection (tables 3,6).…”

Section: Discussionsupporting

confidence: 75%

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Comparison of Fine-Needle Aspiration Biopsy, Doppler Ultrasound, and Radionuclide Scintigraphy in the Diagnosis of Acute Allograft Dysfunction in Renal Transplant Recipients: Sensitivity, Specificity, and Cost Analysis

Delaney¹,

Bn²,

Wg³

et al. 1993

Nephron

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150 episodes of allograft dysfunction in 128 renal transplant recipients, 77 due to acute rejection, 32 secondary to acute-on-chronic rejection, 33 due to either prerenal factors, acute tubular necrosis, or ciclosporin A nephrotoxicity, and 8 secondary to multiple causes, were evaluated by fine-needle aspiration biopsy (FNAB), Doppler ultrasound (DUS), and radionuclide scintigraphy (RS), each performed within a 24-hour period and prior to any specific therapeutic intervention. Tests were interpreted by appropriate specialists in a large transplant center without access to clinical information. The final diagnosis was based primarily upon response to therapeutic maneuvers with histological (core biopsy) confirmation in 123 episodes. RS was the most sensitive (70%) test for the diagnosis of acute rejection during the early posttransplant period, exceeding both FNAB (52%) and DUS (43%). The predictive accuracy of either FNAB, DUS, RS, or core biopsy in the detection of a steroid-responsive component to acute rejection when superimposed upon chronic rejection was low at approximately 50%. When the underlying cause of renal dysfunction was either prerenal, acute tubular necrosis, or ciclosporin A nephrotoxicity, FNAB, DUS, and RS each gave an erroneous diagnosis of acute rejection in about 50% of the episodes. Cost analysis revealed that core biopsy was the most expensive test, but only 9% more than RS, with FNAB the least costly. In conclusion, the lack of ideal sensitivity and specificity combined with the expense of present-day FNAB, DUS, RS, and core biopsy in the diagnosis of a therapeutically reversible component to acute-on-chronic rejection and of FNAB, DUS, and RS in the diagnosis of acute rejection during the early posttransplant period should prompt research into ways to improve their diagnostic yield or alternate modalities.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 75%

Comparison of Fine-Needle Aspiration Biopsy, Doppler Ultrasound, and Radionuclide Scintigraphy in the Diagnosis of Acute Allograft Dysfunction in Renal Transplant Recipients: Sensitivity, Specificity, and Cost Analysis

Delaney¹,

Bn²,

Wg³

et al. 1993

Nephron

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“…Considerable evidence collected over the last decade points to the assessment of the corrected increment (CI) as one the most informative parameters. [18][19][20][21] The present study corroborates the view of elevated CI values as indicative of acute rejection. We found CI values above 2.8 to be highly suggestive of rejection during the first trimester.…”

Section: Discussionsupporting

confidence: 87%

Transplant aspirative cytology: Analysis of morphological and immunocytochemical parameters in renal allograft dysfunction

Castro¹,

González-Posada²,

Lopez‐Tarruella³

et al. 1993

Diagnostic Cytopathology

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We have analyzed 245 transplant aspirative cytologies (TACs) from 96 renal allograft patients. TACs were divided in two chronological groups: Early (TACs performed during the first 3-mo posttransplantation) and late (TACs performed after the third month post-transplantation), in order to assess the effect of allograft tolerance on TAC features. Both morphological and immunocytochemical aspects were evaluated, including CD4, CD8, IL2-R, and HLA-DR immunolabeling. A final diagnosis for each case of allograft dysfunction was achieved by other independent diagnostic means. Four diagnostic groups were considered in the present study: acute rejection (AR), chronic rejection (CR), acute tubular necrosis (ATN), and Cyclosporin A toxicity (CsA-T). In addition, a control group (C) was established from patients with stable allograft function. We found that immunocytochemical analysis of TACs is particularly helpful in the diagnosis of late allograft dysfunction, a time period when the simple cytological study of renal infiltrate is not informative enough to help take therapeutic decisions.

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“…There is cumulative evidence that, as the best way to study the main events involved in allograft rejection, one must search inside the transplanted organ, as the eventual changes appearing at the peripheral blood level show a poor relation to what is happening to the graft [1][2][3][4], Fineneedle aspiration biopsy (FNAB) is a useful and safe method to diagnose a rejection crisis in renal transplant patients [5][6][7][8][9], and moreover it constitutes an excellent way to obtain graft-infiltrating cells (GIC). The character ization of GIC would be a very important step towards the understanding of rejection and tolerance processes.…”

Section: Introductionmentioning

confidence: 99%

Cultures of Aspiration Biopsy Specimens in the Immunological Monitoring of Renal Transplants

Oliveira

Xavier²,

Mendes³

et al. 1997

Nephron

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Objective: Graft-infiltrating cells (GIC) have been studied in heart, lung, and liver transplants and have been shown to have greater proliferative ability when taken from rejecting allografts. Our aim was to study GIC harvested by fine-needle aspiration biopsy (FNAB) in renal transplant recipients. Patients and Methods: 93 adult patients entered the study. The FNABs were done on the 7th, 14th, and 30th day after transplantation in stable cases and whenever a rejection crisis supervened. Results: The proliferation responses of GIC were significantly higher in rejection than in stable cases during the 1st month after transplantation. The sensitivity for rejection was 96.4%, the specificity 91.3%, the negative predictive value 98.7%, and the positive predictive value was 93.3% among dysfunctioning grafts. Conclusions: The study of the proliferative capacity of graft-infiltrating cells in renal transplants is a safe and very useful immunologic monitoring tool, and it could improve the FNAB diagnostic accuracy.

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Confirmation of the Utility of Fine Needle Aspiration Biopsy of the Renal Allograft

Cited by 6 publications

References 0 publications

Comparison of Fine-Needle Aspiration Biopsy, Doppler Ultrasound, and Radionuclide Scintigraphy in the Diagnosis of Acute Allograft Dysfunction in Renal Transplant Recipients: Sensitivity, Specificity, and Cost Analysis

Comparison of Fine-Needle Aspiration Biopsy, Doppler Ultrasound, and Radionuclide Scintigraphy in the Diagnosis of Acute Allograft Dysfunction in Renal Transplant Recipients: Sensitivity, Specificity, and Cost Analysis

Transplant aspirative cytology: Analysis of morphological and immunocytochemical parameters in renal allograft dysfunction

Cultures of Aspiration Biopsy Specimens in the Immunological Monitoring of Renal Transplants

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