Standardizing the histological assessment of late posttransplantation biopsies from pediatric liver allograft recipients

Autor: Stefan G. Hübscher, Sandy Feng, Annette S. H. Gouw, Hironori Haga, Hyo Jeong Kang, Deirdre A. Kelly, Mina Komuta, Andrew Lesniak, Benjamin A. Popp, Henkjan J. Verkade, Eunsil Yu, Anthony J. Demetris
Přispěvatelé: Groningen Institute for Organ Transplantation (GIOT), Center for Liver, Digestive and Metabolic Diseases (CLDM)
Rok vydání: 2022
Předmět:
Zdroj: Liver Transplantation, 28(9), 1475-1489. Wiley
ISSN: 1527-6473
1527-6465
DOI: 10.1002/lt.26482
Popis: Excellent short-term survival after paediatric liver transplantation has shifted attention toward the optimization of long-term outcomes. Despite considerable progress in imaging and other non-invasive modalities, liver biopsies continue to be required to monitor allograft health and to titrate immunosuppression. However, a standardized approach to the detailed assessment of long-term graft histology is currently lacking. The aim of this study was to formulate a list of histopathological features relevant for the assessment of long-surviving liver allograft health and to develop an approach for assessing the presence and severity of these features in a standardised manner. Whole slide digital images from 31 biopsies obtained ≥ 4 years post-transplant to determine eligibility for an immunosuppression withdrawal trial were selected to illustrate a range of typical histopathological findings seen in children with clinically stable grafts, including those associated with alloantibodies. Fifty histological features were independently assessed and, where appropriate, scored semi-quantitatively by 6 pathologists to determine inter- and intra-observer reproducibility of the histopathological features using unweighted and weighted kappa statistics; the latter metric enabled distinction between minor and major disagreements in parameter severity scoring. Weighted inter-observer kappa statistics showed a high level of agreement for various parameters of inflammation, interface activity, fibrosis, and microvascular injury. Intra-observer agreement for these features was even more substantial. The results of this study will help to standardize the assessment of biopsies from long-surviving liver allografts, aid the recognition of important histological features and facilitate international comparisons and clinical trials aiming to improve outcomes for children undergoing liver transplantation.
Databáze: OpenAIRE
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