Human kidney graft survival correlates with structural parameters in baseline biopsies: a quantitative observational cohort study with more than 14 years’ follow-up

Ellingsen, Anne Ringer; Jørgensen, Kaj Anker; Østerby, Ruth; Petersen, Steffen E.; Juul, Svend; Marcussen, Niels; Nyengaard, Jens Randel

doi:10.1007/s00428-020-02924-3

Cited by 3 publications

(3 citation statements)

References 46 publications

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“…are known to influence long-term graft function, [12][13][14] and similar findings have been reported in recipients of living donor kidneys. 15 However, numerous posttransplant immunological and nonimmunological factors affect the transplanted kidney possibly diminishing the value of histomorphometric parameters assessed at the time of transplantation.…”

Section: Introductionsupporting

confidence: 71%

“…This is in accordance with a recent Danish study analyzing biopsies from living or deceased donors using light and electron microscopy and with a follow-up time of 14 y concluding that less hyaline arteriolar thickening and less interstitial fibrosis is associated with long-term graft survival. 13 In the present investigation, focusing on 1-y GFR of the transplanted kidney, the degree of interstitial fibrosis remained a significant marker rendering the use of quantitative glomerular histology of limited use as regards short-term graft function. Fibrosis development is especially worsened by calcineurin inhibitor (CNI) treatment, which probably explains the predictive value of this parameter in recipients and not in LKDs.…”

Section: Discussionmentioning

confidence: 89%

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Prediction of Renal Function in Living Kidney Donors and Recipients of Living Donor Kidneys Using Quantitative Histology

et al. 2022

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Background. Living kidney donors (LKDs) are at increased risk of chronic kidney disease, whereas transplant recipients experience progressive reduction of graft function. We examined the predictive value of quantitative stereology on renal function in LKDs and recipients of living donor kidneys, based on perioperative biopsies from the donated kidney. Methods. Cortex volume of both donor kidneys was determined by contrast-enhanced computed tomography and single-kidney glomerular filtration rate (GFR) by 51chrome-EDTA clearance together with renography. Glomerular density was used to estimate total glomeruli number in addition to glomerular volume, glomerular sclerosis, kidney fibrosis, and arteriole dimensions. GFR measurements were repeated 1 y after transplantation in both LKDs and recipients. Associations between GFR at follow-up and cortex volume and histomorphometric parameters after adjustment of age, gender, body mass index, smoking status, 24-h blood pressure, and single-kidney GFR were examined. Results. We included 49 LKDs (age, 51 ± 12 y) and 51 recipients (age, 44 ± 13 y). At follow-up, GFR was 71 ± 16 mL/min in LKDs and 61 ± 18 mL/min in recipients with hyperfiltration being more prominent in LKDs (30.4%) as compared to recipients (16.4%; P < 0.05). One-year GFR in donors correlated to cortex volume (P < 0.001) but not to any histological parameters, whereas GFR in recipients correlated to the amount of interstitial fibrosis (P < 0.01) but not to other histological parameters or cortex volume. Conclusions. Kidney cortex volume, but not renal histology parameters, predicts 1-y renal outcome in LKDs. In contrast, the amount of interstitial fibrosis, but not cortex volume, predicts 1-y graft function in recipients.

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Section: Introductionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 89%

Prediction of Renal Function in Living Kidney Donors and Recipients of Living Donor Kidneys Using Quantitative Histology

et al. 2022

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“…Although our studies already explored multiple MRI sequences, additional magnetic resonance acquisition methods could make a significant contribution to the future assessment of presumably suboptimal donor kidneys. Currently, the detection and quantification of relevant parenchymal pathology such as interstitial fibrosis, a strong predictor of long‐term graft survival, 28 requires an invasive diagnostic needle biopsy. Yet, application of this gold standard procedure is limited due to risks of serious complications and the very small amount of tissue that can be obtained, which may not reflect the condition of the whole organ and makes these biopsies susceptible to sampling error 29–33 .…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging during warm ex vivo kidney perfusion

et al. 2022

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Background The shortage of donor organs for transplantation remains a worldwide problem. The utilization of suboptimal deceased donors enlarges the pool of potential organs, yet consequently, clinicians face the difficult decision of whether these sub‐optimal organs are of sufficient quality for transplantation. Novel technologies could play a pivotal role in making pre‐transplant organ assessment more objective and reliable. Methods Ex vivo normothermic machine perfusion (NMP) at temperatures around 35–37°C allows organ quality assessment in a near‐physiological environment. Advanced magnetic resonance imaging (MRI) techniques convey unique information about an organ's structural and functional integrity. The concept of applying magnetic resonance imaging during renal normothermic machine perfusion is novel in both renal and radiological research and we have developed the first MRI‐compatible NMP setup for human‐sized kidneys. Results We were able to obtain a detailed and real‐time view of ongoing processes inside renal grafts during ex vivo perfusion. This new technique can visualize structural abnormalities, quantify regional flow distribution, renal metabolism, and local oxygen availability, and track the distribution of ex vivo administered cellular therapy. Conclusion This platform allows for advanced pre‐transplant organ assessment, provides a new realistic tool for studies into renal physiology and metabolism, and may facilitate therapeutic tracing of pharmacological and cellular interventions to an isolated kidney.

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Value of original and modified pathological scoring systems for prognostic prediction in paraffin-embedded donor kidney core biopsy

Tan,

Zhang,

Liu

et al. 2024

Renal Failure

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Background No study has validated, compared and adapted scoring systems for prognosis prediction based on donor kidney core biopsy (CB), with less glomeruli than wedge biopsy. Methods A total of 185 donor kidney CB specimens were reviewed using seven scoring systems. The association between the total score, item scores, score-based grading, and allograft prognosis was investigated. In specimens with less than ten glomeruli (88/185, 47.6%), scoring systems were modified by adjusting weights of the item scores. Results The Maryland aggregate pathology index (MAPI) score-based grading and periglomerular fibrosis (PGF) associated with delayed graft function (DGF) (Grade: OR = 1.59, p < 0.001; PGF: OR = 1.06, p = 0.006). Total score, score-based grading and chronic lesion score in scoring systems associated with one-year and 3-year eGFR after transplantation. Total-score-based models had similar predictive capacities for eGFR in all scoring systems, except MAPI and Ugarte. Score of glomerulosclerosis (GS), interstitial fibrosis (IF), tubular atrophy (TA), and arteriolar hyalinosis (AH) had good eGFR predictive capacities. In specimens with less than ten glomeruli, modified scoring systems had better eGFR predictive capacities than original scoring systems. Conclusions Scoring systems could predict allograft prognosis in paraffin-embedded CB with ten more glomeruli. A simple and pragmatic scoring system should include GS, IF, TA and AH, with weights assigned based on predictive capacity for prognosis. Replacing GS scores with tubulointerstitial scores could significantly improve the predictive capacity of eGFR. The conclusion should be further validated in frozen section.

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Human kidney graft survival correlates with structural parameters in baseline biopsies: a quantitative observational cohort study with more than 14 years’ follow-up

Cited by 3 publications

References 46 publications

Prediction of Renal Function in Living Kidney Donors and Recipients of Living Donor Kidneys Using Quantitative Histology

Prediction of Renal Function in Living Kidney Donors and Recipients of Living Donor Kidneys Using Quantitative Histology

Magnetic resonance imaging during warm ex vivo kidney perfusion

Value of original and modified pathological scoring systems for prognostic prediction in paraffin-embedded donor kidney core biopsy

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