Does implantation biopsy help in predicting renal allograft management and outcome?

Eapen, Georgie A.; Hinduja, Archana; Abraham, Georgi; Kuruvilla, Sarah; Panicker, Vinod Kumar; Thirumalai, R; Mutreja, J

doi:10.1016/s0041-1345(00)01369-5

Cited by 10 publications

(12 citation statements)

References 4 publications

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“…Eapen et al [26] retrospectively analyzed data on 73 renal allograft recipients, of whom 37 recipients had IB. For all patients, subsequent biopsies were done based on the clinical conditions of the patients.…”

Section: Value Of Implantation Biopsymentioning

confidence: 99%

“…However, when faced with a DD, age alone is not predictive enough to allow the outright exclusion of an organ. Indeed, an age-dependent fall in the GFR is not inevitable [26], suggesting that donor age may in fact be a marker of co-morbid conditions that are associated with aging. In a prospective cohort study, Remuzzi et al [32] assessed outcomes among 62 patients who received one or two histologically evaluated kidneys from donors older than 60 years of age.…”

Section: Value Of Implantation Biopsymentioning

confidence: 99%

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Can Donor Implantation Renal Biopsy Predict Long-Term Renal Allograft Outcome?

El-Husseini¹,

Sabry²,

Zahran³

et al. 2007

Am J Nephrol

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Background: Donor kidney implantation biopsy (IB) is performed on a regular basis, particularly as part of clinical studies. Objective: To determine the utility of donor implantation renal biopsy to predict the long-term renal allograft outcome. Methods: A Medline search for studies in English was performed with the following key words: implantation biopsy, renal transplantation and long-term outcome. Results: Sixteen trials involving 8,122 kidney transplants were identified, of which 6 were prospective studies. The histological abnormalities were scored mainly by the Banff schema and the graft outcome was defined either by delineating the delta changes in the pathology score or glomerular filtration rate. Normal histology with a well-functioning renal allograft had a favorable outcome. The extent to which the baseline tubular atrophy, interstitial fibrosis, glomerulosclerosis and vascular changes had on the long-term outcome varied from one study to another. Conclusion: Abnormal IB has a better chance of predicting early graft outcome. The review questions the current wisdom for routine IB on all donors. In some donor kidneys, a biopsy provides significant prognostic information, such as older donor kidney, those with history of hypertension, diabetes, cardiovascular disease, and kidneys with abnormal creatinine. Future research on IB is necessary to find a more useful method to predict the long-term transplant outcome.

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Section: Value Of Implantation Biopsymentioning

confidence: 99%

Section: Value Of Implantation Biopsymentioning

confidence: 99%

Can Donor Implantation Renal Biopsy Predict Long-Term Renal Allograft Outcome?

El-Husseini¹,

Sabry²,

Zahran³

et al. 2007

Am J Nephrol

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“…ATI in literature has been inconsistently associated with DGF, AR, and lower creatinine at various time points post‐transplantation . This variability in the literature largely reflects the differing criteria used to assess ATI and in turn to relate it to outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown to be present in 65% of biopsies with allograft dysfunction during the first week post‐transplantation but is also common in protocol biopsies of stable post‐transplant kidneys . In reviewing the studies on acute injury, there is conflicting data about its impact on graft outcomes . Some small studies have noted a correlation with DGF and rejection; other studies, however, were unable to find any correlation with graft outcomes .…”

Section: Introductionmentioning

confidence: 99%

“…Some studies have evaluated ATI by looking at different histologic features such as epithelial swelling, loss of brush border, cytoplasmic vacuolization, apoptosis (assessed by staining or with morphologic appearance), and infiltration of inflammatory cells . Other studies, however, defined tubular injury as the presence of acute tubular necrosis (ATN) on implantation biopsy with inconsistent correlations with graft outcomes. The term “ATN” is used in these studies without clear definition or grading of the level and severity of tubular injury and usually classified as present or absent.…”

Section: Introductionmentioning

confidence: 99%

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Correlation of acute tubular injury in reperfusion biopsy with renal transplant outcomes

Oppong

Farber

Chervoneva

et al. 2016

Clinical Transplantation

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Acute tubular injury (ATI) is common at reperfusion, but its relationship to graft outcomes is unclear. Prior studies lack standardization of morphological assessments and included elements of acute and chronic tubular injury. This study aimed to evaluate the impact of ATI on graft outcomes. Reperfusion biopsies from 2004 to 2009 were retrospectively reviewed. ATI was assessed by a new standardized scoring system. We also assessed chronic injury (CI) by the Banff criteria. Outcomes evaluated included glomerular filtration rate (GFR) at 1 and 5 years and delayed graft function (DGF), acute rejection (AR), graft and patient survival. ATI did not correlate with DGF, AR, graft or overall survival. Mild-moderate ATI was not predictive of GFR post-transplant. Moderate-severe CI was associated with lower GFR at 5 years with a mean difference of -7.14 mL/min/1.73 m(2) (P=.04) and overall survival (HR 2.44, P=.01). Other predictors of graft function included donor age, DGF, and AR. Histologic criteria of ATI at implantation in the absence of donor demographics or clinical information do not provide sufficient predictability in outcomes after transplantation. On the other hand, histologic assessment of CI correlates with GFR and overall survival.

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Assessment of kidney organ quality and prediction of outcome at time of transplantation

2011

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The critical importance of donor organ quality, i.e., number of surviving nephrons, ability to withstand injury, and capacity for repair in determining short- and long-term outcomes is becoming increasingly clear. This review provides an overview of studies to assess donor kidney quality and subsequent transplant outcomes based on clinical pathology and transcriptome-based variables available at time of transplantation. Prediction scores using clinical variables function when applied to large data sets but perform poorly for the individual patient. Histopathology findings in pre-implantation or post-reperfusion biopsies help to assess structural integrity of the donor kidney, provide information on pre-existing donor disease, and can serve as a baseline for tracking changes over time. However, more validated approaches of analysis and prospective studies are needed to reduce the number of discarded organs, improve allocation, and allow prediction of outcomes. Molecular profiling detects changes not seen by morphology or captured by clinical markers. In particular, molecular profiles provide a quantitative measurement of inflammatory burden or immune activation and reflect coordinated changes in pathways associated with injury and repair. However, description of transcriptome patterns is not an end in itself. The identification of predictive gene sets and the application to an individualized patient management needs the integration of clinical and pathology-based variables, as well as more objective reference markers of transplant function, post-transplant events, and long-term outcomes.

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Does implantation biopsy help in predicting renal allograft management and outcome?

Cited by 10 publications

References 4 publications

Can Donor Implantation Renal Biopsy Predict Long-Term Renal Allograft Outcome?

Can Donor Implantation Renal Biopsy Predict Long-Term Renal Allograft Outcome?

Correlation of acute tubular injury in reperfusion biopsy with renal transplant outcomes

Assessment of kidney organ quality and prediction of outcome at time of transplantation

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