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Functional Characterization of Regulatory Macrophages That Inhibit Graft-reactive Immunity
Published on: June 7, 2017
Macrophage index predicts short-term renal allograft function and graft survival
Titte R Srinivas1, Paul S Kubilis, Byron P Croker
1Division of Nephrology, University of Florida, Gainesville, Florida, USA.
Abstract:
The ability to predict renal allograft dysfunction in the short term and predict graft survival by quantifying the macrophage infiltrate in allograft renal biopsies is described. Renal allograft biopsies performed for cause in 41 consecutive patients were scored for macrophages (macrophage index, MI) by use of a modified Banff score of inflammation (BSI), and the impact of the MI on serum creatinine (SCr) levels 3 months post-biopsy (post-Bx) and on graft survival was quantified. Biopsies were stained for macrophages, individual lesions semiquantified and MI, BSI and chronic allograft damage index (CADI) obtained. The effects of pathologic indices on 3 month post-Bx SCr and graft survival were quantified by multivariate analysis and Cox regression. Glomerular and interstitial macrophage scores correlated inversely with graft survival. MI predicted an increase in SCr 3 months post-Bx (P=0.02). MI >3 (hazard ratio 23.13, P=0.003) also had a powerful negative predictive value on graft survival.
Insights
Quantifying macrophages in kidney transplant biopsies can predict early dysfunction and long-term graft survival. A higher macrophage index (MI) in biopsies indicates a greater risk of transplant complications.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pathology
Background:
- Kidney allograft dysfunction and graft survival are critical concerns in transplantation.
- Accurate prediction of short-term dysfunction and long-term graft survival is essential for patient management.
Purpose of the Study:
- To evaluate the ability of macrophage infiltration in renal allograft biopsies to predict short-term dysfunction and long-term graft survival.
- To quantify the impact of the macrophage index (MI) on serum creatinine (SCr) levels and graft survival post-biopsy.
Main Methods:
- Renal allograft biopsies from 41 patients were analyzed for macrophage infiltration using a modified Banff score of inflammation (BSI).
- Macrophage index (MI), BSI, and chronic allograft damage index (CADI) were calculated.
- Multivariate analysis and Cox regression were used to assess the impact of pathological indices on SCr and graft survival.
Main Results:
- Glomerular and interstitial macrophage scores showed an inverse correlation with graft survival.
- The macrophage index (MI) predicted an increase in serum creatinine (SCr) at 3 months post-biopsy (P=0.02).
- An MI >3 was associated with a significantly higher risk of graft loss (hazard ratio 23.13, P=0.003).
Conclusions:
- Macrophage infiltration in renal allograft biopsies is a valuable predictor of both short-term dysfunction and long-term graft survival.
- The macrophage index (MI) serves as a powerful prognostic marker in kidney transplantation.
- Quantification of macrophage infiltrate offers a potential tool for risk stratification and personalized patient management.
