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Computer Aided Decision Support for Post-Transplant Renal Allograft Rejection

  • Conference paper
Acquisition, Analysis and Use of Clinical Transplant Data

Part of the book series: Lecture Notes in Medical Informatics ((LNMED,volume 34))

  • 26 Accesses

Abstract

Following renal transplantation a patient has to be monitored closely in order to detect the onset of a rejection episode as soon as possible. The decision whether to enhance immuno-suppressive therapy - with its severe side effects - to suppress the rejection episode is often difficult, especially for the less experienced clinician. Therefore, objective methods of decision support are needed. The decision is based on observing the time course of clinical parameters like serum creatinine, urea, urine volume, urinary sodium, osmolarity, and body weight.

Our contribution deals with three questions:

  1. (1)

    What is the distribution of rejection episodes over time elapsed since transplantation?

  2. (2)

    How can current values of clinical parameters be predicted from past observations and the discrepancies between prediction and observation be used for the diagnosis of an episode?

  3. (3)

    Which of the variables have the highest diagnostic value?

For (1) we use a nonparametric kernel method with automatic bandwidth choice by cross-validation. For (2) we developed a nonparametric kernel regression estimator with one-sided kernels. For (3) we employ logistic regression and other multivariate discriminant methods. Future prospects are to implement the developed Fortran programs on a microcomputer in order to supply online decision support.

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References

  1. Persijn GG, Gabb BW, van Leeuwen A, Nagetagaal A, Hoogeboom J, van Rood JJ: Matching for HLA antigens of A,B, and DR loci in renal transplantation by Eurotransplant. Lancet 1978; 1:1278–81.

    Article  PubMed  CAS  Google Scholar 

  2. Ting A, Morris PJ: Matching for B-cell antigens of the HLA-DR series in cadaver renal transplantation. Lancet 1978,1: 575–77.

    Article  PubMed  CAS  Google Scholar 

  3. Albrechtsen D, Arnesen E, Solheim BG, Thorsby E: Significance of HLA-DR matching and of B cell cross-match texts in vitro and in cadaver renal transplantation. Transplant.Proc. 1979; 9:743.

    Google Scholar 

  4. Albrechtson D, Flatmarck A, Jervell J: HLA-DR matching in cadaver renal transplantation. Lancet 1978; 1:825

    Article  Google Scholar 

  5. Opelz G, Sengar DPS, Mickey MR, Terasaki PI: Effect of blood transfusions on subsequent kidney transplants. Transplant. Proc. 1973; 5:253–59.

    PubMed  CAS  Google Scholar 

  6. Opelz G, Terasaki PI: Improvement of kidney graft survival with increased numbers of blood transfusions. New Engl J Med 1980; 299: 799–803.

    Article  Google Scholar 

  7. Calne RY: Immunosuppression for organ grafting. Observations on cyclosporin A. Immunol. Rev. 1979; 46:113.

    Article  CAS  Google Scholar 

  8. European Multicenter Trial Group: Cyclosporin in cadaveric renal transplantation: one-year follow-up of a multicentre trial. Lancet 1983; 2:986.

    Article  Google Scholar 

  9. Strom TB, Tilney NL: Renal transplantation: Clinical Aspects. In: Brenner BM, Rector FC (eds.): The Kidney. W.B. Saunders Company, Philadelphia, 1986, p. 1941.

    Google Scholar 

  10. Carpenter CB, Marrill JP: Histocompatibility and transplantation. In: Harrisons Principles of Internal Medicine. Mc Graw-Hill Internat. Book Company, ninth edition, 1980, pp. 360.

    Google Scholar 

  11. Brunner FP, Brynger H, Chantier C., Douckerwolcke RA, Hathway RA, Jacobs C, Selwood MH, Wing AJ: Combined report on regular dialysis and transplantation in Europe IX 1978. Proc. Eur. Dial. Transplant Assoc. 1979; 16:4.

    PubMed  CAS  Google Scholar 

  12. Opelz G: Collaborative Transplant Study. CTS Newsletter. 1986;1.

    Google Scholar 

  13. Carpenter CB: The early diagnosis of renal allograft rejection in man. Advances in Nephrology from the Necker Hospital (Chicago) 1975; 5: 229–56.

    CAS  Google Scholar 

  14. Huland H, Klosterhalfen H: Pathomechanismus, Morphologie, Diagnostik und Therapie der Abstoßung transplantierter Nieren. Urologe A 1982; 21: 265–73.

    PubMed  CAS  Google Scholar 

  15. Maher JF: A logical approach to the diagnosis of renal transplant rejection. Immunologic, ischemie and inflammatory impairment of renal function. Am J Med 1974, 56: 275.

    Article  PubMed  CAS  Google Scholar 

  16. Mitch WE, Walser M, Buffington GA, Lemann J: A simple method of estimating progression of chronic renal failure. The Lancet 1976: 1326-28.

    Google Scholar 

  17. Rutherford WE, Blondin J, Miller JP, Greennalt AS, Vavra JD: Chronic progressive renal disease: rate of change of serum creatinine concentration. Kidney Intern. 1977, 11:62–70.

    Article  CAS  Google Scholar 

  18. Knapp MS, Smith AFM, Trimble IM, Pownall R, Gordon K: Mathematical and statistical aids to evaluate data from renal patients. Kidney International 1983, 24: 474–86

    Article  PubMed  CAS  Google Scholar 

  19. Trimble IM, West M, Knapp M, Pownall R, Smith AFM: Detection of renal allograft rejection by computer. British medical journal 1933; 5, 286: 1695–1699.

    Google Scholar 

  20. Review anonymous: Kidneys and computers. British medical journal 1980: 281: 1302-3.

    Google Scholar 

  21. Smith AFM, West M: Monitoring renal transplants: an application of the multiprocess Kaiman Filter. Biometrics 1983; 39: 867–78.

    Article  PubMed  CAS  Google Scholar 

  22. Kreis H: Transplanted Kidney: Natural History. In: Hamburger J, Crosnier J, Bach JF, Kreis H (eds.): Renal Transplantation. 2nd edition. Williams & Wilkins, Baltimore, 1981, pp. 177.

    Google Scholar 

  23. Clark EA, Terasaki PI, Opelz G, Mickey MR: Cadaver kidney transplant failures at one month. N Engl J Med. 1974; 291: 1099.

    Article  PubMed  CAS  Google Scholar 

  24. Skow PE, Hansen JE: The functional pattern of the cadaveric kidney in early post transplant period. Acta Med. Scand. 1974; 196:285.

    Google Scholar 

  25. Kjellstrand CM, Casali RE, Shideman J, Simmons RL, Buselmeir T, Najarian JS: The etiology and prognosis in acute post-transplant renal failure. Am J Med 1976, 61: 190.

    Article  PubMed  CAS  Google Scholar 

  26. Kreis H, Finch TW, Moreau JF, Noel LH, Lacombe M, Crosnier J: Early renal failure after cadaveric kidney transplantation. In: Hamburger J, Crosnier J, Grünfeld JP, Maxwell MH (eds.): Advances in Nephrology. Year Book Medical Publishers, Chicago, 1979, vol 8, pp 209.

    Google Scholar 

  27. Opelz G, Lenhard V: Immunological factors influencing renal graft survival. Annu Rev Med 1983; 34, 133–44.

    Article  PubMed  CAS  Google Scholar 

  28. Lenhard V, Dreikorn K, Ritz E: Neuere Aspekte der zellvermittelten und humoralen Mechanismen der Abstoßungsreaktion nach Nierentransplantation. In: Dreikorn K, Ritz E (eds.): Aktueller Stand der Nierentransplantation 1982, Nieren-und Hochdruckkrankheiten, 11., 1982; 2: 49-58.

    Google Scholar 

  29. Williams GM: Clinical aspects of allograft rejection. Transplant. Proc. 1974; 6:71.

    PubMed  CAS  Google Scholar 

  30. Williams GM: Clinical course following renal transplantation. In: Morris JP (ed.): Kidney Transplantation. Principles and Practice. Academic Press, London, 1979, pp 203.

    Google Scholar 

  31. Anderson CB, Newton WI: Accelerated human renal allograft rejection. Arch. Surg. 1975; 110: 1230.

    Article  PubMed  CAS  Google Scholar 

  32. Held E, Edmaier MA: Diagnostik der Abstoßungsreaktionen. In: Albert FW, Kreiter H, Jutzler GA, Traut G (eds.): Praxis der Nierentransplantation. III. Symposium. Schattauer Verlag, Stuttgart, 1980, pp175.

    Google Scholar 

  33. Maury CP, Teppo AM: Comparative study of serum amyloid related protein SAA, C-reactive protein, and beta-2-microglobulin as markers of renal allograft rejection. Clin Nephrol 1984; 22(6): 284–92.

    PubMed  CAS  Google Scholar 

  34. Woo KT, Lee EJ, Lau YK, Lim CH: Beta-2-microglobulin in the assessment of renal function of the transplanted kidney. Nephron 1985; 39(3): 223–7.

    Article  PubMed  CAS  Google Scholar 

  35. Barnes RM, Alexander LC, West CR: Beta-2-microglobulin and renal graft rejection: relationship of plasma creatinine during stable transplant function and graft rejection. Transplant Proc Dec 1984; 16(6): 1613–5.

    CAS  Google Scholar 

  36. Seitz R, Lutz M, Michalik R, Lange H, Klingemann HG, Egbring R: Fibronectin plasma levels after cadaver kidney transplantation. Blut 1985; 50(1), 35–43.

    Article  PubMed  CAS  Google Scholar 

  37. Andrassy K, Ritz E: Stellenwert der SDS-Polyacrylamidgel-Elektrophorese bei der Diagnose von Abstoßungsreaktionen nach Nierentransplantation. In: Dreikorn K, Ritz E (eds.): Aktueller Stand der Nierentransplantation. Nieren-und Hochdruckkrankheiten, 6/1982; p 223-225.

    Google Scholar 

  38. Harrison JF, Barnes AD, Blainey JD: Lysozymuria and renal transplantation. Transplantation (Baltimore) Apr 1972; 13(4): 372–7.

    CAS  Google Scholar 

  39. Horpacsy G et al: Changes in serum and urine lysozyme activity after kidney transplantation: Influence of graft function and therapy with azathioprine. Clinical Chemistry (Winston-Salem) 1978; 24(1): 74–9.

    CAS  Google Scholar 

  40. Kutter D: Diagnostische Wertigkeit der Lysozymbestimmung im Harn. Z Med Lab Diagn 1985; 26(1): 21–7.

    PubMed  CAS  Google Scholar 

  41. Wellwood JM, Ellis BG, Hall JH, et al: Early warning of rejection? Br. Med. J. 1973; ii: 261

    Article  Google Scholar 

  42. Ellis L, Mc Swiney RR, Tucker SM: Urinary excretion of lysozyme and N-acetylbeta-D-Glucosaminidase in the diagnosis of renal allograft rejection. Annals of Clinical Biochemistry (Warwick-London) Sep 1978; 15(5): 253–60.

    CAS  Google Scholar 

  43. Bourbouze J, Percheron F, Gluckman JC, Frantz P, Paraire M, Baumann FC, Luciani J, Legrain M: Early monitoring of human renal transplantations by NAG isoenzyme activities in urines. Clin Chim Acta Jul 1985; 149(2-3): 185–95

    Article  CAS  Google Scholar 

  44. Jung K, Diego J, Strobelt V: Diagnostic significance of urinary enzymes in detecting acute rejection crises in renal transplant recipients depending on expression of results illustrated through the example of alanine aminopeptidase. Clin Biochem Aug 1985; 18(4): 257–60.

    Article  CAS  Google Scholar 

  45. Uthmann U, Dreikorn K, Geisen HP: Der Stellenwert von Beta-2-MikroglobulinBestimmungen in Serum und Urin bei der Diagnostik von Funktionsstörungen nach Nierentransplantation. In: see 37. p 84-94.

    Google Scholar 

  46. Fields BL, Sollinger HW, Glass NR, Carlson IH, Beizer FO: Beta-2-Microglobulin versus creatinine as the sole indicator of rejection in renal transplants. Transplantation Proceedings 1984; 6 (Dec) Vol 16, 1591–3.

    PubMed  CAS  Google Scholar 

  47. Braun WE, Merrill JP: Urine fibrinogen fragments in human renal allografts: a possible mechanism of renal injury. N Eng. J Med 1968; 278: 1366.

    Article  CAS  Google Scholar 

  48. Foegh ML, Winchester JF, Zmudha et al: Urine i-TXB2 in renal allograft rejection. The Lancet 1981: 431–34.

    Google Scholar 

  49. Clorius JH, Dreikorn K, Horsch R, Rössler W: Die Bedeutung nuklearmedizinischer Untersuchungen mit 131-J-bzw. 123-J-Hippurat und 99mTc-Pertechnetat nach Nierentransplantation. In: see 37. 59-75.

    Google Scholar 

  50. Carpenter CB, Milford EL: Renal Transplantation: Immunobiology. In: Brenner BM, Rector FC (eds.): The Kidney. W.B. Saunders Company, Philadelphia, 1986, pp 1907.

    Google Scholar 

  51. Mihatsch MJ, Gudat F, Zollinger HU: Morphologische Kriterien der Transplantatabstoßung. In: see 32; pp191.

    Google Scholar 

  52. Spichtin HP, Mihatsch MJ, Oberholzer M, Gudat F, Thiel G, Harder F, Zollinger HU: Nierenbiopsiemorphologie und Prognose des Nierentransplantates. In: see 37; 95-100.

    Google Scholar 

  53. Axelsen RA, Seymour AE, Methew TH, Canny A, Pascoe V: Glomerular transplant rejection: a distinctive pattern of early graft damage. Clin Nephrol Jan 1985, 23(1): 1–11.

    CAS  Google Scholar 

  54. Silverman BW: Density estimation for statistics and data analysis. Chapman and Hall, London, 1986.

    Google Scholar 

  55. Rosenblatt, M: Remarks on some nonparametric estimates of a densitv function. Ann Math Statist 1956; 27: 832–837.

    Article  Google Scholar 

  56. Parzen E: On estimation of a probability density and mode. Ann Math Statist 1962; 33: 1065–76.

    Article  Google Scholar 

  57. Rudemo M: Empirical choice of histograms and Kernel density estimators. Scand J Statist 1982; 9: 65–78.

    Google Scholar 

  58. Müller HG: Boundary effects in nonparametric curve estimation models. In: Havranek T, Sidak Z, Novak M (eds.): Compstat 1984 Physica Verlag, Wien.

    Google Scholar 

  59. Gasser Th, Müller HG: Estimating regression functions and their derivatives by the kernel method. Scand J Statist 1984; 11: 171–84.

    Google Scholar 

  60. Wahba G: Smoothing noisy data with spline functions. Numer Math 1975; 24: 383–93.

    Article  Google Scholar 

  61. Newsletter 27 Eurotransplant Foundation Leiden 4/85.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Institut für med.-biol. Statistik, Ernst-Giller-Str. 20, 3550, Marburg, Germany

    Hans-Georg Müller & Christian Lohrengel

  2. Abtl. Nephrologie, Klinikum Lahnberge, 3550, Marburg, Germany

    Thomas Müller & Harald Lange

  3. Division of Statistics, Univ. of California, Davis, Ca., 95616, USA

    Hans-Georg Müller

Authors
  1. Hans-Georg Müller
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  2. Thomas Müller
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  3. Christian Lohrengel
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  4. Harald Lange
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Editor information

Editors and Affiliations

  1. Wiss. Zentrum Heidelberg, IBM Deutschland GmbH, Tiergartenstraße 15, 6900, Heidelberg, Germany

    Rainer Janßen

  2. Institut für Immunologie, Universität Heidelberg, Im Neuenheimer Feld 305, 6900, Heidelberg, Germany

    Gerhard Opelz

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© 1987 Springer-Verlag Berlin Heidelberg

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Müller, HG., Müller, T., Lohrengel, C., Lange, H. (1987). Computer Aided Decision Support for Post-Transplant Renal Allograft Rejection. In: Janßen, R., Opelz, G. (eds) Acquisition, Analysis and Use of Clinical Transplant Data. Lecture Notes in Medical Informatics, vol 34. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-51003-8_13

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  • DOI: https://doi.org/10.1007/978-3-642-51003-8_13

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-18511-6

  • Online ISBN: 978-3-642-51003-8

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