The reproducibility and predictive value on outcome of renal biopsies from expanded criteria donors
The reproducibility and predictive value on outcome of renal biopsies from expanded criteria donors
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DOI：
10.1038/ki.2013.461
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发表时间：
2014-05-01
影响因子：
19.6
通讯作者：
Seron, Daniel
中科院分区：
文献类型：
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作者：
Azancot, M. Antonieta;Moreso, Francesc;Seron, Daniel
组织学评分的实用性主要以再现性和预后预测价值为评价标准。在这里，我们分析了不同的待命病理学家和回顾性评价的供体活检评估的再现性由一个单一的肾脏病理学家不知情的临床结果。我们还评估了这两种评估对移植物结局的预测价值。在具有以下任一项的供体中进行活检：年龄>= 55岁、高血压、糖尿病、肌酐>1.5 mg/dl或中风。增加根据Banff标准评价的肾小球硬化、间质纤维化、肾小管萎缩、内膜增厚和小动脉玻璃样变性，以获得慢性评分。活检分为轻度（>= 3），中度（4-5），或先进的（6-7）损害，和不可接受的（>= 8）移植的127个肾脏活检。两个读数之间的加权kappa值为0.41（95% CI：0.28-0.54）。肾脏病理学家对活检的评价与12个月肾小球滤过率估计值和一个重要的复合结果变量显著独立相关，包括死亡删失的移植物存活率和达到肾小球滤过率估计值的时间
Reproducibility and predictive value on outcome are the main criteria to evaluate the utility of histological scores. Here we analyze the reproducibility of donor biopsy assessment by different on-call pathologists and the retrospective evaluation by a single renal pathologist blinded to clinical outcomes. We also evaluate the predictive value on graft outcome of both evaluations. A biopsy was performed in donors with any of the following: age >= 55 years, hypertension, diabetes, creatinine >1.5 mg/dl, or stroke. Glomerulosclerosis, interstitial fibrosis, tubular atrophy, intimal thickening, and arteriolar hyalinosis evaluated according to the Banff criteria were added to obtain a chronic score. Biopsies were classified as mild (>= 3), intermediate (4-5), or advanced (6-7) damage, and unacceptable (>= 8) for transplantation of 127 kidneys biopsied. Weighted kappa value between both readings was 0.41 (95% Cl: 0.28-0.54). Evaluation of biopsies by the renal pathologist was significantly and independently associated with estimated 12-month glomerular filtration rate and a significant composite outcome variable, including death-censored graft survival and time to reach an estimated glomerular filtration rate