title: Quantification of interstitial fibrosis by image analysis on routine renal biopsy 1 year after transplantation in patients managed by C2 monitoring of cyclosporine microemulsion.
abstract: BACKGROUND
  Renal interstitial fibrosis (IF), the main histopathologic feature of chronic allograft nephropathy (CAN), may be an important surrogate endpoint for patient follow-up. IF is currently assessed by semiquantitative analysis, but automatic color image analysis may be a more reliable, reproducible method to evaluate IF. We performed a retrospective analysis to calculate IF on routine renal biopsies 1 year after transplantation.
  
  
  METHODS
  Data were obtained from MO2ART, a prospective multicenter trial in which the cyclosporine microemulsion dose was adjusted based on C(2) levels. We included 26 patients in whom routine renal biopsy at 1 year was available from two centers. For each biopsy, a section was analyzed by a program of color segmentation image that automatically extracted green-colored areas characteristic of IF. Results were expressed as percent IF and grade namely grade I, <25%; grade II, 25% to 50%; and grade III, >50%. The results were compared according to clinical and biological data.
  
  
  RESULTS
  The 26 patients had a mean IF score of 0.35 +/- 0.04. We observed 34.6% CAN grade I; 46.1%, grade II; and 19.2%, grade III. Serum creatinine at 3 years was greater in the higher grade of automated IF by repeated ANOVA.
  
  
  CONCLUSIONS
  Automatic quantification of IF on routine biopsy at 1 year after transplantation was predictive of renal outcome. This technique may provide an interesting tool for the early diagnosis of CAN after renal transplantation.
authors.affiliation: Department of Renal Transplantation, Necker Hospital, 149 rue de Sévres, 75015 Paris, France. aude.servais@nck.aphp.fr
authors.forename: A
authors.initials: A
authors.lastname: Servais
authors.forename: V
authors.initials: V
authors.lastname: Meas-Yedid
authors.forename: M
authors.initials: M
authors.lastname: Buchler
authors.forename: E
authors.initials: E
authors.lastname: Morelon
authors.forename: J-C
authors.initials: JC
authors.lastname: Olivo-Marin
authors.forename: E
authors.initials: E
authors.lastname: Thervet
mesh_terms: D000328:Adult; D001706:Biopsy; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D004655:Emulsions; D005260:Female; D005355:Fibrosis / Q000473:pathology*; D005500:Follow-Up Studies; D006650:Histocompatibility Testing; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods
chemical_list: D004655:Emulsions; D007166:Immunosuppressive Agents; D016572:Cyclosporine