Promises of Big Data and Artificial Intelligence in Nephrology and Transplantation

Thongprayoon, Charat; Kaewput, Wisit; Kovvuru, Karthik; Hansrivijit, Panupong; Kanduri, Swetha R; Bathini, Tarun; Chewcharat, Api; Leeaphorn, Napat; Suarez, M; Cheungpasitporn, Wisit

doi:10.3390/jcm9041107

Cited by 52 publications

(50 citation statements)

References 125 publications

(132 reference statements)

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“…Overall, one-year post-transplant outcomes have improved since 2007, when the Centers for Medicare and Medicaid Services (CMS) solid organ transplant regulation was first implemented [40]. However, there is still a lack of long term graft and survival outcomes [41][42][43][44]. Although transplantation with KDPI > 85% kidneys might be associated with an increased delayed graft function rate and reduced graft survival [45], it is clearly evident based on the lower mortality rate that recipients benefit from transplantation of high-KDPI kidneys when compared with those who wait for low-KDPI kidneys [46,47].…”

Section: Discussionmentioning

confidence: 99%

Degree of Glomerulosclerosis in Procurement Kidney Biopsies from Marginal Donor Kidneys and Their Implications in Predicting Graft Outcomes

Cheungpasitporn

Vaitla

Chewcharat

et al. 2020

JCM

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Background: This study aimed to assess the association between the percentage of glomerulosclerosis (GS) in procurement allograft biopsies from high-risk deceased donor and graft outcomes in kidney transplant recipients. Methods: The UNOS database was used to identify deceased-donor kidneys with a kidney donor profile index (KDPI) score > 85% from 2005 to 2014. Deceased donor kidneys were categorized based on the percentage of GS: 0–10%, 11–20%, >20% and no biopsy performed. The outcome included death-censored graft survival, patient survival, rate of delayed graft function, and 1-year acute rejection. Results: Of 22,006 kidneys, 91.2% were biopsied showing 0–10% GS (58.0%), 11–20% GS (13.5%), >20% GS (19.7%); 8.8% were not biopsied. The rate of kidney discard was 48.5%; 33.6% in 0–10% GS, 68.9% in 11–20% GS, and 77.4% in >20% GS. 49.8% of kidneys were discarded in those that were not biopsied. Death-censored graft survival at 5 years was 75.8% for 0–10% GS, 70.9% for >10% GS, and 74.8% for the no biopsy group. Among kidneys with >10% GS, there was no significant difference in death-censored graft survival between 11–20% GS and >20% GS. Recipients with >10% GS had an increased risk of graft failure (HR = 1.27, p < 0.001), compared with 0–10% GS. There was no significant difference in patient survival, acute rejection at 1-year, and delayed graft function between 0% and 10% GS and >10% GS. Conclusion: In >85% KDPI kidneys, our study suggested that discard rates increased with higher percentages of GS, and GS >10% is an independent prognostic factor for graft failure. Due to organ shortage, future studies are needed to identify strategies to use these marginal kidneys safely and improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Degree of Glomerulosclerosis in Procurement Kidney Biopsies from Marginal Donor Kidneys and Their Implications in Predicting Graft Outcomes

Cheungpasitporn

Vaitla

Chewcharat

et al. 2020

JCM

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“…The use of artificial intelligence algorithms and electronic alerts based on the patient health records has enhanced the development of predictive and risk stratification algorithms which have been reported to improve AKI detection [ 51 , 52 , 53 ].…”

Section: Managementmentioning

confidence: 99%

Management of Acute Kidney Injury Following Major Abdominal Surgery: A Contemporary Review

Gameiro

Fonseca

Marques

et al. 2020

JCM

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Acute kidney injury (AKI) is a frequent occurrence following major abdominal surgery and is independently associated with both in-hospital and long-term mortality, as well as with a higher risk of progressing to chronic kidney disease (CKD) and cardiovascular events. Postoperative AKI can account for up to 40% of in-hospital AKI cases. Given the differences in patient characteristics and the pathophysiology of postoperative AKI, it is inappropriate to assume that the management after noncardiac and nonvascular surgery are the same as those after cardiac and vascular surgery. This article provides a comprehensive review on the available evidence on the management of postoperative AKI in the setting of major abdominal surgery.

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“…However, allograft loss remains a major issue for KT patients [3]. While there has been improvement in one-year graft survival and allograft rejection, there is little improvement in the long-term rate of graft loss [4,5]. Current KT surveillance options for allograft injury such as serum creatinine (SCr), urinalysis, urinary protein, donor specific antibody (DSA), and BK virus surveillance have known limitations [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

The Use of Donor-Derived Cell-Free DNA for Assessment of Allograft Rejection and Injury Status

Vaitla

Craici

Leeaphorn

et al. 2020

JCM

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Patient monitoring after kidney transplantation (KT) for early detection of allograft rejection remains key in preventing allograft loss. Serum creatinine has poor predictive value to detect ongoing active rejection as its increase is not sensitive, nor specific for acute renal allograft rejection. Diagnosis of acute rejection requires allograft biopsy and histological assessment, which can be logistically challenging in some cases and carries inherent risk for complications related to procedure. Donor-derived cell-free DNA (dd-cfDNA), DNA of donor origin in the blood of KT recipient arising from cells undergoing injury and death, has been examined as a potential surrogate marker for allograft rejection. A rise in dd-cfDNA levels precedes changes in serum creatinine allows early detections and use as a screening tool for allograft rejection. In addition, when used in conjunction with donor-specific antibodies (DSA), it increases the pre-biopsy probability of antibody-mediated rejection (ABMR) aiding the decision-making process. Advancements in noninvasive biomarker assays such as dd-cfDNA may offer the opportunity to improve and expand the spectrum of available diagnostic tools to monitor and detect risk for rejection and positively impact outcomes for KT recipients. In this this article, we discussed the evolution of dd-cfDNA assays and recent evidence of assessment of allograft rejection and injury status of KT by the use of dd-cfDNA.

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Promises of Big Data and Artificial Intelligence in Nephrology and Transplantation

Cited by 52 publications

References 125 publications

Degree of Glomerulosclerosis in Procurement Kidney Biopsies from Marginal Donor Kidneys and Their Implications in Predicting Graft Outcomes

Degree of Glomerulosclerosis in Procurement Kidney Biopsies from Marginal Donor Kidneys and Their Implications in Predicting Graft Outcomes

Management of Acute Kidney Injury Following Major Abdominal Surgery: A Contemporary Review

The Use of Donor-Derived Cell-Free DNA for Assessment of Allograft Rejection and Injury Status

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