Chronic Allograft Damage Index (CADI) as a Biomarker in Kidney Transplantation

Helanterä, Ilkka; Ortiz, Fernanda; Koskinen, Petri

doi:10.1007/978-94-007-7699-9_34

Cited by 3 publications

(5 citation statements)

References 41 publications

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“…The values from all HPFs were added and subsequently divided by the number of HPFs. Chronic allograft damage index (CADI score) consisting of vascular intimal sclerosis, tubular atrophy, interstitial fibrosis, interstitial inflammation, mesangial matrix, and glomerulosclerosis was calculated for each biopsy . Each parameter was evaluated with a score from 0 to 3, rendering a possible range of total scores between 0 and 18.…”

Section: Methodsmentioning

confidence: 99%

Early introduction of oral paricalcitol in renal transplant recipients. An open-label randomized study

et al. 2017

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In stable renal transplant recipients with hyperparathyroidism, previous studies have indicated that vitamin D agonist treatment might have anti-proteinuric effects. Animal studies indicate possible anti-fibrotic and anti-inflammatory effects. Early introduction of paricalcitol in de novo renal transplant recipients might reduce proteinuria and prevent progressive allograft fibrosis. We performed a single-center, prospective, randomized, open-label trial investigating effects of paricalcitol 2 μg/day added to standard care. Participants were included 8 weeks after engraftment and followed for 44 weeks. Primary end point was change in spot urine albumin/creatinine ratio. Exploratory microarray analyses of kidney biopsies at study end investigated potential effects on gene expression. Secondary end points included change in glomerular filtration rate (GFR), pulse wave velocity (PWV), and endothelial function measured by peripheral arterial tonometry as reactive hyperemia index (RHI). Seventy-seven de novo transplanted kidney allograft recipients were included, 37 receiving paricalcitol. Paricalcitol treatment lowered PTH levels (P = 0.01) but did not significantly reduce albuminuria (P = 0.76), change vascular parameters (PWV; P = 0.98, RHI; P = 0.33), or influence GFR (P = 0.57). Allograft gene expression was not influenced. To summarize, in newly transplanted renal allograft recipients, paricalcitol reduced PTH and was well tolerated without negatively affecting kidney function. Paricalcitol did not significantly reduce/prevent albuminuria, improve parameters of vascular health, or influence allograft gene expression.

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Section: Methodsmentioning

confidence: 99%

Early introduction of oral paricalcitol in renal transplant recipients. An open-label randomized study

et al. 2017

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“…This scoring system provides a quick overview of the severity of chronic alternations. The studies recommend the use of CADI as a part of routine clinical assessment while interpreting transplanted kidney biopsies (4). A strong relationship has been reported between CADI and graft survival and functions (5).…”

Section: Introductionmentioning

confidence: 99%

“…The authors of the present manuscript consider that superior performance of the SMI technique in demonstrating microvasculature might provide new scientific data that allow us to gain insight into the effects of kidney rejection on peripheral vasculature and predict the degree of rejection. The studies in the literature have established a strong relationship between CADI and graft survival and functions (4,5,10,(11)(12)(13). However, no radiological method currently exists that predicts CADI.…”

Section: Introductionmentioning

confidence: 99%

A Comparison between superb microvascular imaging technique and conventional doppler ultrasound in evaluating chronic allograft damage in renal transplant recipients

Gurbuz¹,

Keven²,

Elmali³

et al. 2023

Diagn Interv Radiol

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“…There is also another RLSE—the rate of decline of estimated glomerular filtration rate (eGFR) as a late post-transplant biomarker, that has been deemed acceptable by the FDA for use in a rare condition (chronic antibody-mediated rejection), however this biomarker remains to be validated for general use across clinical trials ( 5 ). Finally the Chronic Allograft Damage Index (CADI) adopts a sum score of six histopathological lesions in transplanted kidneys associated with graft function ( 23 ). CADI has been useful in clinical decision-making, by providing information on extent of chronic injury in the kidney allograft ( 23 ).…”

Section: Introductionmentioning

confidence: 99%

“…Finally the Chronic Allograft Damage Index (CADI) adopts a sum score of six histopathological lesions in transplanted kidneys associated with graft function ( 23 ). CADI has been useful in clinical decision-making, by providing information on extent of chronic injury in the kidney allograft ( 23 ).…”

Section: Introductionmentioning

confidence: 99%

Demonstrating Benefit-Risk Profiles of Novel Therapeutic Strategies in Kidney Transplantation: Opportunities and Challenges of Real-World Evidence

et al. 2022

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While great progress has been made in transplantation medicine, long-term graft failure and serious side effects still pose a challenge in kidney transplantation. Effective and safe long-term treatments are needed. Therefore, evidence of the lasting benefit-risk of novel therapies is required. Demonstrating superiority of novel therapies is unlikely via conventional randomized controlled trials, as long-term follow-up in large sample sizes pose statistical and operational challenges. Furthermore, endpoints generally accepted in short-term clinical trials need to be translated to real-world (RW) care settings, enabling robust assessments of novel treatments. Hence, there is an evidence gap that calls for innovative clinical trial designs, with RW evidence (RWE) providing an opportunity to facilitate longitudinal transplant research with timely translation to clinical practice. Nonetheless, the current RWE landscape shows considerable heterogeneity, with few registries capturing detailed data to support the establishment of new endpoints. The main recommendations by leading scientists in the field are increased collaboration between registries for data harmonization and leveraging the development of technology innovations for data sharing under high privacy standards. This will aid the development of clinically meaningful endpoints and data models, enabling future long-term research and ultimately establish optimal long-term outcomes for transplant patients.

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Chronic Allograft Damage Index (CADI) as a Biomarker in Kidney Transplantation

Cited by 3 publications

References 41 publications

Early introduction of oral paricalcitol in renal transplant recipients. An open-label randomized study

Early introduction of oral paricalcitol in renal transplant recipients. An open-label randomized study

A Comparison between superb microvascular imaging technique and conventional doppler ultrasound in evaluating chronic allograft damage in renal transplant recipients

Demonstrating Benefit-Risk Profiles of Novel Therapeutic Strategies in Kidney Transplantation: Opportunities and Challenges of Real-World Evidence

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