The Maryland aggregate pathology index: a deceased donor kidney biopsy scoring system for predicting graft failure

R B Munivenkatappa; E J Schweitzer; J C Papadimitriou; C B Drachenberg; K A Thom; E N Perencevich; A Haririan; F Rasetto; M Cooper; L Campos; R N Barth; S T Bartlett; B Philosophe

doi:10.1111/j.1600-6143.2008.02370.x

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The Maryland aggregate pathology index: a deceased donor kidney biopsy scoring system for predicting graft failure

Journal article

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The Maryland aggregate pathology index: a deceased donor kidney biopsy scoring system for predicting graft failure

R B Munivenkatappa, E J Schweitzer, J C Papadimitriou, C B Drachenberg, K A Thom, E N Perencevich, A Haririan, F Rasetto, M Cooper, L Campos, …

American journal of transplantation, Vol.8(11), pp.2316-2324

11/2008

DOI: 10.1111/j.1600-6143.2008.02370.x

PMID: 18801024

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Abstract

Despite the common use of diagnostic pretransplant deceased donor kidney biopsy, there is no consensus on the prognostic significance of the pathologic findings. In order to assist clinicians with interpretation we analyzed 371 pretransplant biopsies and correlated the findings with graft failure. Glomerular pathology was assessed with percent glomerulosclerosis (GS), glomerular size and periglomerular fibrosis (PGF); vascular pathology with arterial wall-to-lumen ratio (WLR) and arteriolar hyalinosis and interstitial pathology with measurement of cumulative fibrosis and presence of scar. Using two-thirds of the study population as a model-development cohort, we found that biopsy features independently associated with an increased risk of graft failure were GS > or =15%, interlobular arterial WLR > or =0.5 and the presence of PGF, arteriolar hyalinosis or scar. The Maryland Aggregate Pathology Index (MAPI), was developed from these parameters and validated on the remaining one-third of the population. Five-year actuarial graft survival was 90% for kidneys with MAPI scores between 0 and 7, 63% for scores from 8 to 11 and 53% for scores from 12 to 15 (p < 0.001). We conclude MAPI may help transplant physicians estimate graft survival from the preimplantation biopsy findings, in clinical situations similar to this study population (cold ischemia over 24 h, GS < 25%).

Biopsy - methods

Kidney - pathology

Kidney Diseases - pathology

Humans

Kidney Diseases - diagnosis

Middle Aged

Child, Preschool

Graft Survival

Male

Treatment Outcome

Kidney Transplantation - statistics & numerical data

Kidney Transplantation - methods

Adolescent

Adult

Female

Kidney Transplantation - mortality

Aged

Child

Maryland

Cohort Studies

Details

Title: Subtitle: The Maryland aggregate pathology index: a deceased donor kidney biopsy scoring system for predicting graft failure
Creators: R B Munivenkatappa - Division of Transplantation, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD
E J Schweitzer
J C Papadimitriou
C B Drachenberg
K A Thom
E N Perencevich
A Haririan
F Rasetto
M Cooper
L Campos
R N Barth
S T Bartlett
B Philosophe
Resource Type: Journal article
Publication Details: American journal of transplantation, Vol.8(11), pp.2316-2324
DOI: 10.1111/j.1600-6143.2008.02370.x
PMID: 18801024
NLM abbreviation: Am J Transplant
ISSN: 1600-6143
eISSN: 1600-6143
Publisher: United States
Language: English
Date published: 11/2008
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9984001164102771

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