An automated histological classification system for precision diagnostics of kidney allografts
Daniel Yoo
(1)
,
Valentin Goutaudier
(1, 2)
,
Gillian Divard
(1, 3)
,
Juliette Gueguen
(4)
,
Brad Astor
(5)
,
Olivier Aubert
(6, 1)
,
Marc Raynaud
(1)
,
Zeynep Demir
(1, 2)
,
Julien Hogan
(1, 7)
,
Patricia Weng
(8)
,
Jodi Smith
(9)
,
Rouba Garro
(10)
,
Bradley Warady
(11, 12)
,
Rima Zahr
(13, 14)
,
Marta Sablik
(1)
,
Katherine Twombley
(15)
,
Lionel Couzi
(16)
,
Thierry Berney
(17)
,
Olivia Boyer
(2)
,
Jean-Paul Duong-Van-Huyen
(2)
,
Magali Giral
(18, 19)
,
Alaa Alsadi
(5)
,
Pierre-Antoine Gourraud
(18, 19)
,
Emmanuel Morelon
(20, 21)
,
Moglie Le Quintrec
(22)
,
Sophie Brouard
(18, 19)
,
Christophe Legendre
(1, 2)
,
Dany Anglicheau
(2)
,
Jean Villard
(17)
,
Weixiong Zhong
(5)
,
Nassim Kamar
(23)
,
Oriol Bestard
(24)
,
Arjang Djamali
(25)
,
Klemens Budde
(26, 27, 28)
,
Mark Haas
(29)
,
Carmen Lefaucheur
(1, 3)
,
Marion Rabant
(1, 2)
,
Alexandre Loupy
(1, 2)
1
PARCC (UMR_S 970/ U970) -
Paris-Centre de Recherche Cardiovasculaire
2 Hôpital Necker - Enfants Malades [AP-HP]
3 AP-HP - Hopital Saint-Louis [AP-HP]
4 Hôpital Bretonneau
5 University of Wisconsin-Madison
6 Service Néphrologie et transplantation rénale Adultes [CHU Necker]
7 Hôpital Robert Debré Paris
8 David Geffen School of Medicine [Los Angeles]
9 University of Washington [Seattle]
10 Emory University School of Medicine
11 Children's Mercy Hospital [Kansas City]
12 University of Kansas [Kansas City]
13 UTHSC - The University of Tennessee Health Science Center [Memphis]
14 LBCH - Le Bonheur Children's Hospital [Memphis, TN, USA]
15 MUSC - Medical University of South Carolina [Charleston]
16 CHU Bordeaux
17 HUG - Hôpitaux universitaires de Genève = University Hospitals of Geneva
18 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
19 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
20 Hôpital Edouard Herriot [CHU - HCL]
21 UCBL - Université Claude Bernard Lyon 1
22 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
23 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
24 Vall d'Hebron University Hospital [Barcelona]
25 Maine Medical Center
26 Freie Universität Berlin
27 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
28 BIH - Berlin Institute of Health
29 Cedars-Sinai Medical Center
2 Hôpital Necker - Enfants Malades [AP-HP]
3 AP-HP - Hopital Saint-Louis [AP-HP]
4 Hôpital Bretonneau
5 University of Wisconsin-Madison
6 Service Néphrologie et transplantation rénale Adultes [CHU Necker]
7 Hôpital Robert Debré Paris
8 David Geffen School of Medicine [Los Angeles]
9 University of Washington [Seattle]
10 Emory University School of Medicine
11 Children's Mercy Hospital [Kansas City]
12 University of Kansas [Kansas City]
13 UTHSC - The University of Tennessee Health Science Center [Memphis]
14 LBCH - Le Bonheur Children's Hospital [Memphis, TN, USA]
15 MUSC - Medical University of South Carolina [Charleston]
16 CHU Bordeaux
17 HUG - Hôpitaux universitaires de Genève = University Hospitals of Geneva
18 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
19 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
20 Hôpital Edouard Herriot [CHU - HCL]
21 UCBL - Université Claude Bernard Lyon 1
22 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
23 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
24 Vall d'Hebron University Hospital [Barcelona]
25 Maine Medical Center
26 Freie Universität Berlin
27 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
28 BIH - Berlin Institute of Health
29 Cedars-Sinai Medical Center
Daniel Yoo
- Fonction : Auteur
- PersonId : 1279398
- ORCID : 0000-0002-2153-5093
Valentin Goutaudier
- Fonction : Auteur
- PersonId : 1279399
- ORCID : 0000-0001-6191-6889
Julien Hogan
- Fonction : Auteur
- PersonId : 1279400
- ORCID : 0000-0003-4838-9417
Katherine Twombley
- Fonction : Auteur
- PersonId : 1279401
- ORCID : 0000-0003-2073-2834
Thierry Berney
- Fonction : Auteur
- PersonId : 1274208
- ORCID : 0000-0002-4230-9378
Olivia Boyer
- Fonction : Auteur
- PersonId : 889775
- ORCID : 0000-0002-3957-1359
- IdRef : 11556134X
Dany Anglicheau
- Fonction : Auteur
- PersonId : 773300
- ORCID : 0000-0001-5793-6174
Jean Villard
- Fonction : Auteur
- PersonId : 1279402
- ORCID : 0000-0003-2667-7506
Oriol Bestard
- Fonction : Auteur
- PersonId : 795412
- ORCID : 0000-0001-9468-7920
Klemens Budde
- Fonction : Auteur
- PersonId : 1279403
- ORCID : 0000-0002-7929-5942
Alexandre Loupy
- Fonction : Auteur
- PersonId : 762676
- ORCID : 0000-0003-3388-7747
Résumé
For three decades, the international Banff classification has been the gold standard for kidney allograft rejection diagnosis, but this system has become complex over time with the integration of multimodal data and rules, leading to misclassifications that can have deleterious therapeutic consequences for patients. To improve diagnosis, we developed a decision-support system, based on an algorithm covering all classification rules and diagnostic scenarios, that automatically assigns kidney allograft diagnoses. We then tested its ability to reclassify rejection diagnoses for adult and pediatric kidney transplant recipients in three international multicentric cohorts and two large prospective clinical trials, including 4,409 biopsies from 3,054 patients (62.05% male and 37.95% female) followed in 20 transplant referral centers in Europe and North America. In the adult kidney transplant population, the Banff Automation System reclassified 83 out of 279 (29.75%) antibody-mediated rejection cases and 57 out of 105 (54.29%) T cell-mediated rejection cases, whereas 237 out of 3,239 (7.32%) biopsies diagnosed as non-rejection by pathologists were reclassified as rejection. In the pediatric population, the reclassification rates were 8 out of 26 (30.77%) for antibody-mediated rejection and 12 out of 39 (30.77%) for T cell-mediated rejection. Finally, we found that reclassification of the initial diagnoses by the Banff Automation System was associated with an improved risk stratification of long-term allograft outcomes. This study demonstrates the potential of an automated histological classification to improve transplant patient care by correcting diagnostic errors and standardizing allograft rejection diagnoses
Domaines
Sciences du Vivant [q-bio]
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