Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Surveillance biopsy remains debated after renal transplantation since the histological diagnostic do not lead to clear therapeutic recommendations. The main objective for this study was to identify and validate a clinical diagnostic signature of histological lesions from surveillance biopsy at one year after renal transplantation.
Patients and methods:
From the DIVAT cohort, we studied 567 adult recipients of kidney or kidney-pancreas, transplanted between 2006 and 2012, from deceased donor, and alive with a functioning graft at one year post-transplantation. Patients displaying major histological lesions comprising allo-immunity (i.e. Borderline, acute or chronic humoral and/or cellular rejection), IFTA grade 2 or 3 and initial disease relapse were compared with patients presenting minor lesions (i.e. Normal histology or IFTA grade 1). The diagnostic signature was identified using a lasso penalized logistic regression and internally validated by ROC 0.632+ bootstrap.
303 patients (53%) were diagnosed with minor histological lesions. The diagnostic signature included 8 variables. Women recipients (OR=2.70), patients with a kidney transplant alone (OR=1.36), with high serum creatinine at 3 months (OR=1.05), 6 months (OR=1.58) and 12 months (OR=1.42), receiving a male kidney (OR=1.48), with anti-class II immunization at transplantation time (OR=1.47) and who experienced dialysis before transplantation (OR=2.81) are more at risk of major histological lesions. The area under the associated ROC curve is estimated at 0.69. We assumed a minimal negative predictive value at 75% leading to a discriminating threshold. In this medical decision making perspective, 17% of patients have a good chance to display minor lesions and a surveillance biopsy should not be proposed.
This diagnostic signature can help physicians to not recommend surveillance biopsies in patients at high risk of minor lesions and therefore avoid unnecessary biopsies.
To cite this abstract in AMA style:Dantan E, Renaudin K, Brouard S, Huneau A, Paul C, Giral M. A Clinical Signature Surrogate of Histological Lesions to Avoid Unnecessary One Year Surveillance Biopsy After Renal Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/a-clinical-signature-surrogate-of-histological-lesions-to-avoid-unnecessary-one-year-surveillance-biopsy-after-renal-transplantation/. Accessed September 22, 2019.
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