Early subclinical tubulitis and interstitial inflammation in kidney transplantation have adverse clinical implications

Abstract

The Nijmegen Biomedical Study is a population-based cross-sectional study conducted in the eastern part of the Netherlands. As part of the overall study, we provide reference values of estimated glomerular filtration rate (GFR) for this Caucasian population without expressed risk. Age-stratified, randomly selected inhabitants received a postal questionnaire on lifestyle and medical history. In a large subset of the responders, serum creatinine was measured. The GFR was then measured using the abbreviated Modification of Diet in Renal Disease (MDRD) formula. To limit possible bias, serum creatinine was calibrated against measurements performed in the original MDRD laboratory. The study cohort included 2823 male and 3274 female Caucasian persons aged 18-90 years. A reference population of apparently healthy subjects was selected by excluding persons with known hypertension, diabetes, cardiovascular-or renal diseases. This healthy study cohort included 1660 male subjects and 2072 female subjects, of which 869 of both genders were 65 years or older. The median GFR was 85 ml/min/1.73 m 2 in 30-to 34-year-old men and 83 ml/min/1.73 m 2 in similar aged women. In these healthy persons, GFR declined approximately 0.4 ml/min/year. Our study provides age-and gender-specific reference values of GFR in a population of Caucasian persons without identifiable risk.

Kidney allograft rejection: Diagnosis and treatment practices in USA‐ A UNOS survey

“…Our survey questionnaire did not explicitly differentiate between acute and chronic TCMR or ABMR, and treatment responses could differ for various forms of ABMR as reported by Schinstock et al 11 The survey does not dissect out what Banff classification iteration the responders used for their decision making at their center. Based on the particular Banff iteration used, the reported incidence of certain forms of rejection (namely borderline changes) may change 14 . Our survey did not include centers’ use of recent advances like cell‐free DNA for rejection surveillance.…”

Molecular patterns of isolated tubulitis differ from tubulitis with interstitial inflammation in early indication biopsies of kidney allografts

“…It is focused primarily on the diagnosis of rejection (either T-cell mediated (TCMR), antibody-mediated or mixed rejection). The Banff category of borderline (suspicious) for acute TCMR (BL) describes changes insufficient for a diagnosis of rejection, the clinical significance of which has been widely debated in recent years [1][2][3] . BL was introduced into the Banff classification as early as 1997 4 , and besides tubulitis this category required inflammation in at least 10% of non-scarred cortex tissue (Banff i > 0).…”

Impact of HLA Mismatching on Early Subclinical Inflammation in Low-Immunological-Risk Kidney Transplant Recipients

“…SCI exists in about 40–50% of allograft kidneys when protocol biopsies are performed routinely [ 5 , 34 ]. These lesions indicate an ongoing inflammation status that could perpetuate over time, evolving to chronic histological changes and allograft dysfunction [ 5 , 6 , 7 , 35 , 36 ]. In our study, the HLA mismatching score was an independent risk factor for early SCI (3rd month) despite the patients having a low-immunological risk at the time of KT.…”