Open AccessThe 1‐year Renal Biopsy Index: a scoring system to drive biopsy indication at 1‐year post‐kidney transplantation
Author(s) -
Giral Magali,
Renaudin Karine,
Naesens Maarten,
Luning Redmer,
Anglicheau Dany,
Morelon Emmanuel,
Huneau Alexandre,
Paul Chloé,
Brouard Sophie,
CouvratDesvergnes Grégoire,
Foucher Yohann,
Dantan Etienne
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13290
Subject(s) - medicine , transplantation , biopsy , histology , kidney transplantation , nephrology , renal biopsy , creatinine , cohort , surgery , urology
Summary Surveillance biopsies after renal transplantation remain debatable. To drive the decision of such intervention, we propose a predictive score of abnormal histology at 1‐year post‐transplantation, named 1‐year Renal Biopsy Index (1‐ RBI ). We studied 466 kidney recipients from the DIVAT cohort alive with a functioning graft and a surveillance biopsy at 1‐year post‐transplantation. Patients displaying abnormal histology (49%) (borderline, acute rejection, interstitial fibrosis and tubular atrophy [ IFTA ] grade 2 or 3, glomerulonephritis) were compared to the normal or subnormal ( IFTA grade 1) histology group. Obtained from a lasso penalized logistic regression, the 1‐ RBI was composed of recipient gender, serum creatinine at 3, 6, and 12 month post‐transplantation and anticlass II immunization at transplantation (internal validation: AUC = 0.71, 95% CI [0.53–0.83]; external validation: AUC = 0.62, 95% CI [0.58–0.66]). While we could not determinate a threshold able to identify patients at high chance of normal or subnormal histology, we estimated and validated a discriminating threshold capable of identifying a subgroup of 15% of the patients with a risk of abnormal histology higher than 80%. The 1‐ RBI is computable online at www.divat.fr . The 1‐ RBI could be a useful tool to standardize 1‐year biopsy proposal and may for instance help to indicate one in case of high risk of abnormal histology.