Abstract
Although controversial, procurement kidney biopsies and histology are commonly used in kidney allocation from deceased donors. The long series of models developed for this question, incorporating a variety of clinical and histologic variables, failed to properly predict the long-term graft survival. This failure could be explained by many factors, including the lack of expertise in terms of skilled available nephropathologists in the urgent setting of biopsies assessment. Simulation-based learning is a form of experiential learning that provides learners with a real-world-like opportunity to develop and practice their knowledge and skills but in a simulated environment. Digital pathology with whole-slide imaging is a powerful tool for knowledge delivering, as it offers the opportunity to facilitate meeting of general pathologists with experts, with availability of second opinion consultation and tailored training on specific cases. In the back of these considerations, we report on the content of the web-meeting “Digital slide and simulation-based learning in pre-implantation kidney” which was fully dedicated to the evaluation of pre-implantation kidney biopsy, with a very practical approach and a direct interaction between two expert renal transplant pathologists and the audience of general pathologists.
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Introduction
For patients in end-stage renal disease, renal transplantation is the therapy of choice, as it improves patients’ survival and quality of life, but demand for organs is still higher than the offer. Therefore, it is of paramount importance to avoid inappropriate organ discard and maximize retrieval also from extended criteria donors (ECD). Pre-implantation biopsy is usually undertaken to evaluate the suitability of the kidneys in ECDs, although there are still many challenges in the management and assessment. Apart from the modality of bioptic sampling (wedge versus needle core vs the recently introduced punch biopsy), there is conflicting evidence on which histological parameters best represent the possible outcome of the transplantation [1]. Kidney biopsy for organ suitability is usually assessed with Remuzzi/Karpinski scores, or slight modifications of them, and these comprise evaluation of glomerulosclerosis (GS), interstitial fibrosis (IF), tubular atrophy (TA), and arterial arteriosclerotic narrowing [2]. To complicate things, kidney biopsies for organ suitability are usually evaluated by on-call pathologists with no specific expertise in renal pathology, and published evidence has highlighted that expertise and training have great influence on final score of biopsy and therefore potential discard or inappropriate allocation, with different correlation to final outcome [3, 4••]. Moreover, detection of subtle alterations in kidney such as thrombotic microangiopathy or tubular necrosis or grading diabetic damage which can have a great influence on graft function in the recipient can be very challenging for general pathologists with no specific expertise in this specific field.
Digital pathology with whole-slide imaging (WSI) has shown to be reliable for transplant biopsy evaluation and in general for transplant services [5,6,7,8]. Moreover, it is a powerful instrument for knowledge delivering, as it offers the opportunity to facilitate meeting of general pathologists with experts, with availability of second opinion consultation and tailored training on specific cases [9•].
In the back of these considerations, we report on the content of the web meeting “Digital slide and simulation-based learning in pre-implantation kidney,” held on Zoom platform on January 20, 2023 (Fig. 1). The meeting was fully dedicated to the evaluation of pre-implantation kidney biopsy, with a very practical approach and a direct interaction between two expert renal transplant pathologists and the audience of general pathologists and nephrologists. Several pathognomonic and challenging cases of kidney biopsies from real-life practice were explained and discussed by the experts as the main goal of this meeting was to offer a permanent access to this piece of knowledge for all the reading pathologists involved in pre-implantation kidney biopsy evaluation. Before starting the discussion, the experts reported their experience on how to procedurally manage each single case, with periodic acid Schiff (PAS) and trichrome stains recommended for a correct and easier identification of structures and alterations in pre-transplant kidney biopsy.
Meeting Overview
A total of 53 slides referring to 22 different cases were scanned with 3DHisthec Pannoramic scanner to a maximum magnification of 40 × and uploaded on a dedicated platform, where they were available to all the attendees before and after the meeting. File size ranged from 108.83 MB to 1.6 GB, and for most of the cases, both a PAS and a trichrome stain were available, sometimes together with other additional special and immunohistochemical stains. The cases have been divided and discussed into specific sections starting from basics on how to evaluate adequacy to most challenging cases.
Final Remarks
Simulation-based learning via digital pathology provides learners with a real-world-like opportunity to develop and practice their knowledge and skills but in a simulated environment. Digital events like this highlight the positive potential of digital solution for delivering knowledge to the interested audience even for niche fields of pathology like transplant pathology and offer the opportunity to improve the interaction of the several actors (clinicians, diagnosticians, technical professionals, vendors etc.) of a healthcare community.
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Naesens M. Zero-time renal transplant biopsies: a comprehensive review. Transplantation. 2016;100:1425–39. https://doi.org/10.1097/TP.0000000000001018.
Remuzzi G, Grinyò J, Ruggenenti P, Beatini M, Cole EH, Milford EL, Brenner BM. Early experience with dual kidney transplantation in adults using expanded donor criteria. J Am Soc Nephrol. 1999;10:2591–8. https://doi.org/10.1681/ASN.V10122591.
Antonieta Azancot M, Moreso F, Salcedo M, Cantarell C, Perello M, Torres IB, Montero A, Trilla E, Sellarés J, Morote J, et al. The reproducibility and predictive value on outcome of renal biopsies from expanded criteria donors. Kidney Int. 2014;85:1161–8. https://doi.org/10.1038/ki.2013.461.
Girolami I, Gambaro G, Ghimenton C, Beccari S, Caliò A, Brunelli M, Novelli L, Boggi U, Campani D, Zaza G, et al. Pre-implantation kidney biopsy: value of the expertise in determining histological score and comparison with the whole organ on a series of discarded kidneys. J Nephrol. 2020;33:167–76. https://doi.org/10.1007/s40620-019-00638-7. Demonstrates the role of expertise in determining histological score in pre-implantation kidney biopsies.
Eccher A, Neil D, Ciangherotti A, Cima L, Boschiero L, Martignoni G, Ghimenton C, Chilosi M, Giobelli L, Zampicinini L, et al. Digital reporting of whole-slide images is safe and suitable for assessing organ quality in preimplantation renal biopsies. Hum Pathol. 2016;47:115–20. https://doi.org/10.1016/j.humpath.2015.09.012.
Cima L, Brunelli M, Parwani A, Girolami I, Ciangherotti A, Riva G, Novelli L, Vanzo F, Sorio A, Cirielli V, et al. Validation of remote digital frozen sections for cancer and transplant intraoperative services. J Pathol Inform. 2018;9:34. https://doi.org/10.4103/jpi.jpi_52_18.
Eccher A, Girolami I, Brunelli M, Novelli L, Mescoli C, Malvi D, D’Errico A, Luchini C, Furian L, Zaza G, et al. Digital pathology for second opinion consultation and donor assessment during organ procurement: review of the literature and guidance for deployment in transplant practice. Transplant Rev. 2020;34:100562. https://doi.org/10.1016/j.trre.2020.100562.
Girolami I, Parwani A, Barresi V, Marletta S, Ammendola S, Stefanizzi L, Novelli L, Capitanio A, Brunelli M, Pantanowitz L, et al. The landscape of digital pathology in transplantation: from the beginning to the virtual E-slide. J Pathol Inform. 2019;10:21. https://doi.org/10.4103/jpi.jpi_27_19.
Neri F, Eccher A, Rigotti P, Girolami I, Zaza G, Gambaro G, Mastrosimini M, Bencini G, Bella C, Mescoli C, et al. Advantages of using a web-based digital platform for kidney preimplantation biopsies. J Pathol Inform. 2021;12:41. https://doi.org/10.4103/jpi.jpi_23_21. The digital platform lays the foundation for the introduction of artificial intelligence in the field of transplantation that would help create new diagnostic algorithms and tools with the final aim of increasing the precision of organ assessment and its predictive value for transplant outcome.
Acknowledgements
The meeting and the digital platform were supported by Epredia® and I&C Congresses provider.
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Open access funding provided by Università degli Studi di Verona within the CRUI-CARE Agreement.
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Eccher, A., Antonini, P., Barreca, A. et al. Digital Slide and Simulation-Based Learning in Pre-Implantation Kidney Biopsies. Curr Transpl Rep 10, 40–50 (2023). https://doi.org/10.1007/s40472-023-00392-7
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DOI: https://doi.org/10.1007/s40472-023-00392-7