Assessment of the Utility of Kidney Histology as a Basis for Discarding Organs in the United States: A Comparison of International Transplant Practices and Outcomes.

peer reviewedBACKGROUND: Many kidneys donated for transplant in the United States are discarded because of abnormal histology. Whether histology adds incremental value beyond usual donor attributes in assessing allograft quality is unknown. METHODS: This population-based study included patients who received a deceased donor kidney that had been biopsied before implantation according to a prespecified protocol in France and Belgium, where preimplantation biopsy findings are generally not used for decision making in the allocation process. We also studied kidneys that had been acquired from deceased United States donors for transplantation that were biopsied during allocation and discarded because of low organ quality. Using donor and recipient characteristics, we fit multivariable Cox models for death-censored graft failure and examined whether predictive accuracy (C index) improved after adding donor histology. We matched the discarded United States kidneys to similar kidneys transplanted in Europe and calculated predicted allograft survival. RESULTS: In the development cohort of 1629 kidney recipients at two French centers, adding donor histology to the model did not significantly improve prediction of long-term allograft failure. Analyses using an external validation cohort from two Belgian centers confirmed the lack of improved accuracy from adding histology. About 45% of 1103 United States kidneys discarded because of histologic findings could be accurately matched to very similar kidneys that had been transplanted in France; these discarded kidneys would be expected to have allograft survival of 93.1% at 1 year, 80.7% at 5 years, and 68.9% at 10 years. CONCLUSIONS: In this multicenter study, donor kidney histology assessment during allocation did not provide substantial incremental value in ascertaining organ quality. Many kidneys discarded on the basis of biopsy findings would likely benefit United States patients who are wait listed

Sensitization in Transplantation: Assessment of Risk (STAR) 2017 Working Group Meeting Report

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144684/1/ajt14752_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144684/2/ajt14752.pd

The Banff 2019 Kidney Meeting Report (I): Updates on and clarification of criteria for T cell– and antibody-mediated rejection

The XV. Banff conference for allograft pathology was held in conjunction with the annual meeting of the American Society for Histocompatibility and Immunogenetics in Pittsburgh, PA (USA) and focused on refining recent updates to the classification, advances from the Banff working groups, and standardization of molecular diagnostics. This report on kidney transplant pathology details clarifications and refinements to the criteria for chronic active (CA) T cell–mediated rejection (TCMR), borderline, and antibody-mediated rejection (ABMR). The main focus of kidney sessions was on how to address biopsies meeting criteria for CA TCMR plus borderline or acute TCMR. Recent studies on the clinical impact of borderline infiltrates were also presented to clarify whether the threshold for interstitial inflammation in diagnosis of borderline should be i0 or i1. Sessions on ABMR focused on biopsies showing microvascular inflammation in the absence of C4d staining or detectable donor-specific antibodies; the potential value of molecular diagnostics in such cases and recommendations for use of the latter in the setting of solid organ transplantation are presented in the accompanying meeting report. Finally, several speakers discussed the capabilities of artificial intelligence and the potential for use of machine learning algorithms in diagnosis and personalized therapeutics in solid organ transplantation

Eine Kultur des Wandels schaffen

Einführung und Begrüßung zum Vortrag durch den Rektor Prof. Dr. Hans Herbert von Arnim, S. 5-7

Le paysage politique de l'Allemagne réunifiée

The Political Landscape of Unifïed Germany, by Peter Glotz Reunification happened so suddenly that neither Helmut Kohi nor any other German politician was fully in control of the situation and it has left Germany weakened and perplexed. While indecision undermines German foreign policy makers, their neighbours accuse them periodically of a désire for hegemony. On the domestic front, political parties are having difficulty adapting to the new situation, which is allowing free play to the increasingly active extreme right, who, it is feared, may be a destabilising force. Furthermore, certain conservative circles, conscious of a reawakening of national sentiment, wish to call into question the present strengthening of Community powers as they have a different view of Europe's future.La réunification, survenue si soudainement et sur laquelle ni Helmut Kohi ni aucun autre homme politique allemand n'a eu de réelle emprise, laisse l'Allemagne affaiblie et perplexe. Pourtant, alors que l'indécision mine la politique étrangère de la RFA, ses voisins lui intentent parfois des procès d'intentions hégémoniques. Sur la scène politique nationale, les partis amorcent difficilement leur adaptation à la nouvelle donne, ce qui laisse les coudées plus franches à une extrême droite de plus en plus active et dont on peut craindre le rôle déstabilisateur. De plus, s'appuyant sur la renaissance d'une « pensée nationale » allemande, certains cercles conservateurs remettent désormais en question l'approfondissement de la Communauté et envisagent l'Europe sous une forme différente.Glotz Peter. Le paysage politique de l'Allemagne réunifiée. In: Politique étrangère, n°4 - 1991 - 56ᵉannée. pp. 891-897