title: Scoring total inflammation is superior to the current Banff inflammation score in predicting outcome and the degree of molecular disturbance in renal allografts.
abstract: Emerging molecular analysis can be used as an objective and independent assessment of histopathological scoring systems. We compared the existing Banff i-score to the total inflammation (total i-) score for assessing the molecular phenotype in 129 renal allograft biopsies for cause. The total i-score showed stronger correlations with microarray-based gene sets representing major biological processes during allograft rejection. Receiver operating characteristic curves showed that total-i was superior (areas under the curves 0.85 vs. 0.73 for Banff i-score, p = 0.012) at assessing an abnormal cytotoxic T-cell burden, because it identified molecular disturbances in biopsies with advanced scarring. The total-i score was also a better predictor of graft survival than the Banff i-score and essentially all current diagnostic Banff categories. The exception was antibody-mediated rejection which is able to predict graft loss with greater specificity (96%) but at low sensitivity (38%) due to the fact that it only applies to cases with this diagnosis. The total i-score is able to achieve moderate sensitivities (60-80%) with losses in specificity (60-80%) across the whole population. Thus, the total i-score is superior to the current Banff i-score and most diagnostic Banff categories in predicting outcome and assessing the molecular phenotype of renal allografts.
authors: Department of Laboratory Medicine and Pathology, Alberta Transplant Applied Genomics Centre, Canada. mmengel@ualberta.ca
authors: M
authors: M
authors: Mengel
authors: J
authors: J
authors: Reeve
authors: S
authors: S
authors: Bunnag
authors: G
authors: G
authors: Einecke
authors: G S
authors: GS
authors: Jhangri
authors: B
authors: B
authors: Sis
authors: K
authors: K
authors: Famulski
authors: L
authors: L
authors: Guembes-Hidalgo
authors: P F
authors: PF
authors: Halloran
mesh_terms: D001706:Biopsy; D002465:Cell Movement; D006801:Humans; D007249:Inflammation / Q000175:diagnosis* / Q000473:pathology*; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013602:T-Lymphocytes, Cytotoxic / Q000473:pathology; D014184:Transplantation, Homologous