Human kidney graft survival correlates with structural parameters in baseline biopsies: a quantitative observational coh
- PDF / 553,942 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 42 Downloads / 189 Views
ORIGINAL ARTICLE
Human kidney graft survival correlates with structural parameters in baseline biopsies: a quantitative observational cohort study with more than 14 years’ follow-up Anne R. Ellingsen 1,2,3,7 Jens R. Nyengaard 1,7,8
4
1
5
6
& Kaj A. Jørgensen & Ruth Østerby & Steffen E. Petersen & Svend Juul & Niels Marcussen
3
&
Received: 28 February 2020 / Revised: 26 August 2020 / Accepted: 2 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract This prospective cohort study evaluates associations between structural and ultrastructural parameters in baseline biopsies from human kidney transplants and long-term graft survival after more than 14 years’ follow-up. Baseline kidney graft biopsies were obtained prospectively from 54 consecutive patients receiving a kidney transplant at a single institution. Quantitative measurements were performed on the baseline biopsies by computer-assisted light microscopy and electron microscopy. Stereology-based techniques estimated the fraction of interstitial tissue, the volume of glomeruli, mesangial fraction, and basement membrane thickness of glomerular capillaries. The fraction of occluded glomeruli and scores according to the Banff classification were achieved. Kidney graft survival was analyzed by Kaplan–Meier estimates and Cox regression. Association to long-term kidney function was also analyzed. The long-term surviving kidney transplants were characterized at implantation by less arteriolar hyaline thickening (P < 0.001) and less interstitial fibrosis (P = 0.001), as well as a lower fraction of occluded glomeruli (P = 0.004) and lower glomerular volume (P = 0.03). At the latest follow-up, eGFR was decreased by 12 ml/min/1.73 m2 per unit increase in the score for arteriolar hyalinosis at implantation (P = 0.02), and eGFR was decreased by 19 ml/min/1.73 m2 per 106 μm3 increase in glomerular volume at baseline (P = 0.03). The unbiased Cavalieri estimate of glomerular volume and the ultrastructural parameters are the first to be evaluated in a cohort study with prospective follow-up for more than 14 years. The study shows that baseline biopsies from human kidney grafts contain extraordinary long-term prognostic information, and it highlights the importance of these intrinsic graft factors. Keywords Baseline biopsy . Cohort study . Human kidney graft . Long term . Morphometry . Prospective . Quantification . Stereology . Structural parameters Niels Marcussen and Jens R. Nyengaard contributed equally and share authorship This article is part of the Topical Collection on Quality in Pathology Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00428-020-02924-3) contains supplementary material, which is available to authorized users. * Anne R. Ellingsen [email protected] 1
Electron Microscopy Laboratory, Aarhus University Hospital, 8200 Aarhus N, Denmark
2
Department of Pathology, Aarhus University Hospital, 8200 Aarhus N, Denmark
3
Department of Clinical Pathology, Odense Universit
Data Loading...
