Histopathologic Evaluation of Pretransplantation Biopsy as a Factor Influencing Graft Function After Kidney Transplantation in 3-Year Observation

Sulikowski, Tadeusz; Tejchman, Karol; Ziętek, Z; Urasińska, Elżbieta; Domański, Leszek; Sieńko, Jerzy; Romanowski, M; Safranow, Krzysztof; Żukowski, Maciej; Ciechanowicz, Andrzej; Ciechanowski, Kazimierz; Ostrowski, Marek

doi:10.1016/j.transproceed.2010.08.060

Cited by 19 publications

(21 citation statements)

References 31 publications

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“…S1). In addition, more extensive necrosis than this is observed posttransplantation in deceased cardiac death (DCD) donor kidneys, which have more prolonged warm ischemic times (30). Given the increasing use of DCD donor kidneys as a result of organ shortage, our findings are likely to be applicable to this important clinical scenario.…”

Section: Discussionmentioning

confidence: 83%

Magnetic resonance imaging with hyperpolarized [1,4- ¹³ C ₂ ]fumarate allows detection of early renal acute tubular necrosis

Clatworthy

Kettunen

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

104

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Acute kidney injury (AKI) is a common and important medical problem, affecting 10% of hospitalized patients, and it is associated with significant morbidity and mortality. The most frequent cause of AKI is acute tubular necrosis (ATN). Current imaging techniques and biomarkers do not allow ATN to be reliably differentiated from important differential diagnoses, such as acute glomerulonephritis (GN). We investigated whether 13 C magnetic resonance spectroscopic imaging (MRSI) might allow the noninvasive diagnosis of ATN. C]lactate ratio showed substantial variability and was not significantly decreased in animals with ATN or increased in animals with GN. In conclusion, MRSI of hyperpolarized [1,[4][5][6][7][8][9][10][11][12][13] C 2 ]fumarate allows the detection of early tubular necrosis and its distinction from glomerular inflammation in murine models. This technique may have the potential to identify a window of therapeutic opportunity in which emerging therapies might be applied to patients with ATN, reducing the need for acute dialysis with its attendant morbidity and cost.hyperpolarization | MRI

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Section: Discussionmentioning

confidence: 83%

Magnetic resonance imaging with hyperpolarized [1,4- ¹³ C ₂ ]fumarate allows detection of early renal acute tubular necrosis

Clatworthy

Kettunen

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

104

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“…In aggregate, prior studies of histologic AKI by preimplantation biopsy have reported inconsistent associations with allograft outcomes (Table 2) (17)(18)(19)(20)(21)(22)(23). None of the studies that we identified provided magnitudes of association or confidence intervals for histologic AKI, and only one study analyzed multicenter data (21).…”

Section: Discussionmentioning

confidence: 85%

Preimplant Histologic Acute Tubular Necrosis and Allograft Outcomes

Hall

Reese

Weng³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives The influence of deceased-donor AKI on post-transplant outcomes is poorly understood. The few published studies about deceased-donor preimplant biopsy have reported conflicting results regarding associations between AKI and recipient outcomes.Design, setting, participants, & measurements This multicenter study aimed to evaluate associations between deceased-donor biopsy reports of acute tubular necrosis (ATN) and delayed graft function (DGF), and secondarily for death-censored graft failure, first adjusting for the kidney donor risk index and then stratifying by donation after cardiac death (DCD) status.Results Between March 2010 and April 2012, 651 kidneys (369 donors, 4 organ procurement organizations) were biopsied and subsequently transplanted, with ATN reported in 110 (17%). There were 262 recipients (40%) who experienced DGF and 38 (6%) who experienced graft failure. DGF occurred in 45% of kidneys with reported ATN compared with 39% without ATN (P=0.31) resulting in a relative risk (RR) of 1.13 (95% confidence interval [95% CI], 0.9 to 1.43) and a kidney donor risk index-adjusted RR of 1.11 (95% CI, 0.88 to 1.41). There was no significant difference in graft failure for kidneys with versus without ATN (8% versus 5%). In stratified analyses, the adjusted RR for DGF with ATN was 0.97 (95% CI, 0.7 to 1.34) for non-DCD kidneys and 1.59 (95% CI, 1.23 to 2.06) for DCD kidneys (P=0.02 for the interaction between ATN and DCD on the development of DGF).Conclusions Despite a modest association with DGF for DCD kidneys, this study reveals no significant associations overall between preimplant biopsy-reported ATN and the outcomes of DGF or graft failure. The potential benefit of more rigorous ATN reporting is unclear, but these findings provide little evidence to suggest that current ATN reports are useful for predicting graft outcomes or deciding to accept or reject allograft offers.

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“…Twenty-two of 61 in the GFT group had both preimplantation and postreperfusion biopsies performed: 18 showed GFT on both biopsies, 3 had GFT on postreperfusion biopsy only and 1 had GFT on the preimplantation biopsy only. The median for the number of glomeruli in the reperfusion biopsies was 15 (25-75% range: [11][12][13][14][15][16][17][18][19][20] in the GFT group and 14 (25-75% range: 10-21) in the control group (p ¼ 0.87).…”

Section: Resultsmentioning

confidence: 99%

“…Studies investigating the relationship between acute tubular necrosis and graft outcome have yielded variable results (16)(17)(18)(19). Despite the lack of consistent data, our protocol is to exclude kidneys if a preimplantation biopsy shows >10% CNTEC, a finding that we would interpret as severe acute tubular injury.…”

Section: Discussionmentioning

confidence: 99%

Rapid Resolution of Donor-Derived Glomerular Fibrin Thrombi After Deceased Donor Kidney Transplantation

Batra

Heilman

Smith

et al. 2016

American Journal of Transplantation

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The aim of this study was to determine the clinical and histologic outcomes related to transplanting kidneys from deceased donors with glomerular fibrin thrombi (GFT). We included all cases transplanted between October 2003 and October 2014 that had either a preimplantation biopsy or an immediate postreperfusion biopsy showing GFT. The study cohort included 61 recipients (9.9%) with GFT and 557 in the control group without GFT. Delayed graft function occurred in 49% of the GFT group and 39% in the control group (p ¼ 0.14). Serum creatinine at 1, 4, and 12 months and estimated GFR at 12 months were similar in the two groups. Estimated 1-year graft survival was 93.2% in the GFT group and 95.1% in the control group (p ¼ 0.22 by logrank). Fifty-two of the 61 patients in the GFT group (85%) had a 1-month protocol biopsy, and only two biopsies (4%) showed residual focal glomerular thrombi. At the 1-year protocol biopsy, the prevalence of moderate to severe interstitial fibrosis and tubular atrophy was 24% in the GFT group and 30% in the control group (p ¼ 0.42). We concluded that GFT resolves rapidly after transplantation and that transplanting selected kidneys from deceased donors with GFT is a safe practice.

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Histopathologic Evaluation of Pretransplantation Biopsy as a Factor Influencing Graft Function After Kidney Transplantation in 3-Year Observation

Cited by 19 publications

References 31 publications

Magnetic resonance imaging with hyperpolarized [1,4- ¹³ C ₂ ]fumarate allows detection of early renal acute tubular necrosis

Magnetic resonance imaging with hyperpolarized [1,4- ¹³ C ₂ ]fumarate allows detection of early renal acute tubular necrosis

Preimplant Histologic Acute Tubular Necrosis and Allograft Outcomes

Rapid Resolution of Donor-Derived Glomerular Fibrin Thrombi After Deceased Donor Kidney Transplantation

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Histopathologic Evaluation of Pretransplantation Biopsy as a Factor Influencing Graft Function After Kidney Transplantation in 3-Year Observation

Cited by 19 publications

References 31 publications

Magnetic resonance imaging with hyperpolarized [1,4- 13 C 2 ]fumarate allows detection of early renal acute tubular necrosis

Magnetic resonance imaging with hyperpolarized [1,4- 13 C 2 ]fumarate allows detection of early renal acute tubular necrosis

Preimplant Histologic Acute Tubular Necrosis and Allograft Outcomes

Rapid Resolution of Donor-Derived Glomerular Fibrin Thrombi After Deceased Donor Kidney Transplantation

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Magnetic resonance imaging with hyperpolarized [1,4- ¹³ C ₂ ]fumarate allows detection of early renal acute tubular necrosis

Magnetic resonance imaging with hyperpolarized [1,4- ¹³ C ₂ ]fumarate allows detection of early renal acute tubular necrosis