دورية أكاديمية
Potential and Uncertainties of RejectClass in Acute Kidney Graft Dysfunction: An Independent Validation Study.
| العنوان: | Potential and Uncertainties of RejectClass in Acute Kidney Graft Dysfunction: An Independent Validation Study. |
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| المؤلفون: | von Samson-Himmelstjerna FA; Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Germany., Kakavand N; Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Germany., Gleske C; Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany., Schraml F; Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany., Basta AA; Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany., Braunisch MC; Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany., Bräsen JH; Nephropathology Unit, Department of Pathology, Hannover Medical School, Hannover, Germany., Schmitz J; Nephropathology Unit, Department of Pathology, Hannover Medical School, Hannover, Germany., Kraus D; Department of Nephrology, Department of Internal Medicine 1, University Medical Center Mainz, Mainz, Germany., Weinmann-Menke J; Department of Nephrology, Department of Internal Medicine 1, University Medical Center Mainz, Mainz, Germany., Zacharias HU; Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany., Vaulet T; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium., Naesens M; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium., Krautter M; Department of Nephrology, Transplant Center, Klinikum Stuttgart, Stuttgart, Germany., Schwenger V; Department of Nephrology, Transplant Center, Klinikum Stuttgart, Stuttgart, Germany., Esser G; Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Germany., Kolbrink B; Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Germany., Amann K; Department of Nephropathology, University Hospital Erlangen, University of Erlangen-Nürnberg, Erlangen, Germany., Holzmann-Littig C; Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany., Echterdiek F; Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany., Kunzendorf U; Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Germany., Renders L; Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany., Schulte K; Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Germany., Heemann U; Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany. |
| مؤلفون مشاركون: | TRABIO study group |
| المصدر: | Transplantation [Transplantation] 2024 May 01; Vol. 108 (5), pp. 1228-1238. Date of Electronic Publication: 2024 Apr 24. |
| نوع المنشور: | Journal Article; Validation Study; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0132144 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-6080 (Electronic) Linking ISSN: 00411337 NLM ISO Abbreviation: Transplantation Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Hagerstown, MD : Lippincott Williams & Wilkins Original Publication: Baltimore, Williams & Wilkins. |
| مواضيع طبية MeSH: | Kidney Transplantation*/adverse effects , Graft Rejection*, Humans ; Male ; Female ; Middle Aged ; Retrospective Studies ; Adult ; Biopsy ; Graft Survival ; Algorithms ; Risk Factors ; Phenotype ; Proportional Hazards Models ; Acute Disease ; Kidney/physiopathology ; Kidney/pathology ; Reproducibility of Results ; Germany/epidemiology ; Risk Assessment ; Aged ; Predictive Value of Tests ; Time Factors ; Treatment Outcome |
| مستخلص: | Background: Kidney graft rejections are classified based on the Banff classification. The RejectClass algorithm, initially derived from a cohort comprising mostly protocol biopsies, identifies data-driven phenotypes of acute rejection and chronic pathology using Banff lesion scores. It also provides composite scores for inflammation activity and chronicity. This study independently evaluates the performance of RejectClass in a cohort consisting entirely of indication biopsies. Methods: We retrospectively applied RejectClass to 441 patients from the German TRABIO (TRAnsplant BIOpsies) cohort who had received indication biopsies. The primary endpoint was death-censored graft failure during 2 y of follow-up. Results: The application of RejectClass to our cohort demonstrated moderately comparable phenotypic features with the derivation cohort, and most clusters indicated an elevated risk of graft loss. However, the reproduction of all phenotypes and the associated risks of graft failure, as depicted in the original studies, was not fully accomplished. In contrast, adjusted Cox proportional hazards analyses substantiated that both the inflammation score and the chronicity score are independently associated with graft loss, exhibiting hazard ratios of 1.7 (95% confidence interval, 1.2-2.3; P = 0.002) and 2.2 (95% confidence interval, 1.8-2.6; P < 0.001), respectively, per 0.25-point increment (scale: 0.0-1.0). Conclusions: The composite inflammation and chronicity scores may already have direct utility in quantitatively assessing the disease stage. Further refinement and validation of RejectClass clusters are necessary to achieve more reliable and accurate phenotyping of rejection. Competing Interests: F.A.v.S.-H. and B.K. are supported by the Medical Faculty of the Christian-Albrechts-University Kiel. J.H.B. and J.S. were supported by the Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung [BMBF], KMU-innovativ: grant 13GW0399B). H.U.Z. was supported by the BMBF within the framework of the e:Med research and funding concept (grant 01ZX1912A). The other authors declare no conflicts of interest. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.) |
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| معلومات مُعتمدة: | n/a Chiesi GmbH (Hamburg, Germany); n/a Stiftung Lebendspende (Munich, Germany) |
| تواريخ الأحداث: | Date Created: 20240110 Date Completed: 20240425 Latest Revision: 20240426 |
| رمز التحديث: | 20240426 |
| مُعرف محوري في PubMed: | PMC11042522 |
| DOI: | 10.1097/TP.0000000000004906 |
| PMID: | 38196094 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1534-6080 |
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| DOI: | 10.1097/TP.0000000000004906 |