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Assessment of kidney organ quality and prediction of outcome at time of transplantation

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Abstract

The critical importance of donor organ quality, i.e., number of surviving nephrons, ability to withstand injury, and capacity for repair in determining short- and long-term outcomes is becoming increasingly clear. This review provides an overview of studies to assess donor kidney quality and subsequent transplant outcomes based on clinical pathology and transcriptome-based variables available at time of transplantation. Prediction scores using clinical variables function when applied to large data sets but perform poorly for the individual patient. Histopathology findings in pre-implantation or post-reperfusion biopsies help to assess structural integrity of the donor kidney, provide information on pre-existing donor disease, and can serve as a baseline for tracking changes over time. However, more validated approaches of analysis and prospective studies are needed to reduce the number of discarded organs, improve allocation, and allow prediction of outcomes. Molecular profiling detects changes not seen by morphology or captured by clinical markers. In particular, molecular profiles provide a quantitative measurement of inflammatory burden or immune activation and reflect coordinated changes in pathways associated with injury and repair. However, description of transcriptome patterns is not an end in itself. The identification of predictive gene sets and the application to an individualized patient management needs the integration of clinical and pathology-based variables, as well as more objective reference markers of transplant function, post-transplant events, and long-term outcomes.

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Acknowledgments

We want to thank Dr Valerie Luyckx for her critical reading of the manuscript and the many suggestions made.

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  1. Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Thomas F. Mueller

  2. Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada

    Kim Solez

  3. Departments of Surgery and Pathology, Director Molecular Transplant Research Laboratory, Division of Transplant, Virginia Commonwealth University, Richmond, VA, USA

    Valeria Mas

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  1. Thomas F. Mueller
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Correspondence to Thomas F. Mueller.

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Mueller, T.F., Solez, K. & Mas, V. Assessment of kidney organ quality and prediction of outcome at time of transplantation. Semin Immunopathol 33, 185–199 (2011). https://doi.org/10.1007/s00281-011-0248-x

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