Practicing Renal Transplant Pathology in a Developing Country: Challenges and Opportunities

Mubarak, Muhammed

doi:10.4172/2161-0991.1000e118

Cited by 4 publications

(5 citation statements)

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“…Predictors of chronic rejection are secondary to poor compliance, lack of induction therapy and multiple episodes of acute rejection [ 44 ]. Access to support services, including transplant histopathology, monitoring of viral load and drug level, access to vaccines, imaging and immunology tests are limited in most LLMIC that contribute to suboptimal outcomes [ 57 ]. Adolescent patients often fall between services and adolescent care is a challenging field especially in under-resourced regions.…”

Section: Transplant Outcomes In Lmicmentioning

confidence: 99%

Paediatric kidney transplantation in under-resourced regions—a panoramic view

Iyengar

McCulloch

2021

Pediatr Nephrol

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Kidney transplantation is the ideal choice of kidney replacement therapy in children as it offers a low risk of mortality and a better quality of life. A wide variance in the access to kidney replacement therapies exists across the world with only 21% of low- and low-middle income countries (LLMIC) undertaking kidney transplantation. Pediatric kidney transplantation rates in these under-resourced regions are reported to be as low as < 4 pmcp [per million child population]. A robust kidney failure care program forms the cornerstone of a transplant program. Even the smallest transplant program entails a multidisciplinary workforce and expertise besides ensuring family commitment towards long-term care and economic burden. In general, the short-term graft survival rates from under-resourced regions are comparable to most high-income countries (HIC) and the challenge lies in the long-term outcomes. This review focuses on specific issues relevant to kidney transplants in children in under-resourced regions by highlighting limitations in the capacity and health workforce, regulatory norms, medical issues, economic burden, factors beyond financial hardship and ethical considerations relevant to these regions. Finally, the perspective of strengthening transplant programs in these regions should factor in the bigger challenges that exist in achieving the health-related sustainable development goals by 2030.

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Section: Transplant Outcomes In Lmicmentioning

confidence: 99%

Paediatric kidney transplantation in under-resourced regions—a panoramic view

Iyengar

McCulloch

2021

Pediatr Nephrol

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“…Numerous advancements and technical innovations in the field of organ transplantation during the last few decades have revolutionized the approaches to the problems faced by the transplant community [2]. However, many formidable challenges still remain, hampering the widespread use of this modality of Renal Replacement Therapy (RRT) throughout the world [1][2][3][4].…”

Section: Cells; Transplantationmentioning

confidence: 99%

“…The causes of dysfunction vary depending on many factors, including the time post-transplant, type of immunosuppression used, living vs. cadaveric origin of the organ, and so on [4]. These often require recourse to the invasive procedure of renal allograft biopsy, which is still the gold standard test for an accurate diagnosis and categorization of rejection, for example [3].…”

Section: Cells; Transplantationmentioning

confidence: 99%

Evolution of the Banff Working Classification of Renal Allograft Pathology: Updates and Future Directions

Mubarak¹

2013

J Transplant Technol Res

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One of the important challenges after renal transplantation is the accurate identification and appropriate management of the graft dysfunction [2,3]. The causes of dysfunction vary depending on many factors, including the time post-transplant, type of immunosuppression used, living vs. cadaveric origin of the organ, and so on [4]. These often require recourse to the invasive procedure of renal allograft biopsy, which is still the gold standard test for an accurate diagnosis and categorization of rejection, for example [3]. The safety and clinical utility of the biopsy has been proved beyond doubt in numerous clinical studies during the last few decades [5][6][7][8][9][10][11]. However, the pathological interpretation of the biopsies is a daunting task and fraught with interobserver variation. Moreover, the pathology of transplantation is continuously evolving [12][13][14][15][16][17]. The Banff classification was introduced to address the above issues in the reporting of renal transplant pathology and to harmonize the reporting of the lesions in a uniform language, which is understood by the clinicians, pathologists, basic scientists and transplant surgeons alike [12,17]. The first meeting of the Banff group took place in 1991 at Banff, Canada and the first detailed publication appeared in 1993 [12,15,17]. Since then, regular meetings of the ever expanding group have been held every two years with timely updates, additions and revisions of the original classification. The aim of these meetings has been to revisit and refine the original classification in the light of accumulating new research and evidence from ongoing studies [12,[17][18][19]. Regarding individual diagnostic categories, major changes have occurred in the categories of antibody-mediated rejection, T-CellMediated Rejection (TCMR) and chronic allograft changes. Some of these evolutionary changes in the diagnostic approach have been reviewed in detail by this author elsewhere [13]. Briefly, the most spectacular changes have taken place in the category of ABMR [13]. The detailed pathology-based diagnostic criteria have been devised and updated for an accurate diagnosis and categorization of ABMR into acute and chronic active categories. The major impetus for this surge in interest in ABMR has been provided by the discovery and the widespread use of c4d as a biomarker for ABMR [20][21][22]. A subtype of ABMR, c4d-negative ABMR has been recognized and a Banff Working Group established to devise the evidence-based criteria of this subtype and to determine the full impact of allo-antibodies on the kidney allograft. A correlation has been found between ABMR diagnosed by histological criteria and molecular profiling. Further work is needed before these diagnostic modalities are merged smoothly into a workable classification [23][24][25][26][27][28]. AbstractRenal transplant pathology is a complex and rapidly evolving field of surgical pathology and the pathologic interpretation of renal allograft biopsy pose significant challenges and opportunities to the ...

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confidence: 99%

“…Due to the correlative nature of renal pathology diagnosis, other investigation modalities such as electron microscopy (EM) and antibodies to localize antigens in tissue sections from percutaneous needle [27][28][29]. Paediatric cases of chronic kidney disease (CKD), especially those from LMICs who often have unrecognized and untreated CKD, progress to ESRD [27,29]. This requires life-saving renal replacement therapy (RRT), which unfortunately is very expensive and therefore unaffordable in most of these developing countries [3,5,[30][31][32].…”

mentioning

confidence: 99%

Advanced diagnostic techniques for paediatric chronic kidney disease in a developing country: A narrative review

Ndu

Ohayi

Edelu

2021

Ukr. J. Nephrol. and Dial.

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Chronic kidney disease (CKD) is described as a complex and progressive condition that arises from both non-communicable diseases (NCD) and communicable diseases (CD). Approximately a tenth of adults are affected worldwide, but the global prevalence of paediatric CKD remains unknown. Unfortunately, advanced diagnostic techniques and interventions are not readily available in most developing countries. This review seeks to create more awareness about paediatric CKD in a developing country like Nigeria and the need to intensify efforts to make new technologies for its diagnosis available and more affordable.

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Practicing Renal Transplant Pathology in a Developing Country: Challenges and Opportunities

Cited by 4 publications

References 0 publications

Paediatric kidney transplantation in under-resourced regions—a panoramic view

Paediatric kidney transplantation in under-resourced regions—a panoramic view

Evolution of the Banff Working Classification of Renal Allograft Pathology: Updates and Future Directions

Advanced diagnostic techniques for paediatric chronic kidney disease in a developing country: A narrative review

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