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MedUni Vienna researchers help to draft new guidelines for diagnosing renal allograft rejection

Željko Kikić and Nicolas Kozakowski take over leadership of working group of BANFF Foundation for Allograft Pathology
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(Vienna, 05 June 2020) Željko Kikić and Nicolas Kozakowski from MedUni Vienna have been invited to work on drafting the BANFF Foundation for Allograft Pathology's international guidelines for diagnosis of renal allograft rejection.

Over the past few years, Željko Kikić from the Department of Medicine III, Division of Nephrology and Dialysis, and Nicolas Kozakowski from the Department of Pathology have contributed to important findings relating to the diagnosis of antibody-mediated rejection in kidney transplant patients.
On the basis of this work, they were invited to work on drafting the BANFF Foundation for Allograft Pathology’s international guidelines for diagnosis of renal allograft rejection. Kikić and Kozakowski took over leadership of the "Peritubular capillaritis" working group and, in collaboration with Ian W. Gibson (University of Manitoba, Canada), they are organising an international, multi-centre study to improve the diagnosis of renal allograft rejection¹.  

The focus of their pioneering work that preceded this study was the role of peritubular capillaritis in the diagnosis and pathogenesis of allograft rejection. Peritubular capillaritis involves the congestion of small renal blood vessels caused by inflammatory cells and can be triggered by T cells or an antibody-mediated immune response. Kikić and Kozakowski carried out several large-scale analyses, in which they were able to show, for the first time, that the diffuse distribution (more than 50% of the renal cortex) of peritubular capillaritis should be regarded as a new, independent risk factor for loss of the transplanted organ². In addition, diffuse peritubular capillaritis was independently associated with subsequent immune-mediated chronic rejection3,4 .

The working group will use innovative approaches such as digital pathology, Deep Learning systems with artificial neuronal networks and molecular investigations to refine the diagnostic accuracy and prognostic value of peritubular capillaritis. This could help to adapt the current BANFF Foundation for Allograft Pathology recommendations, to provide better stratification of at-risk patients and ultimately to increase allograft and patient survival.


Bibliography

1.    Loupy A, Haas M, Roufosse C, et al. The Banff 2019 Kidney Meeting Report (I): Updates on and clarification of criteria for T cell- and antibody-mediated rejection. Am J Transplant 2020.
2.    Kozakowski N, Herkner H, Bohmig GA, et al. The diffuse extent of peritubular capillaritis in renal allograft rejection is an independent risk factor for graft loss. Kidney Int 2015;88:332-40.
3.    Kozakowski N, Herkner H, Eskandary F, et al. An integrative approach for the assessment of peritubular capillaritis extent and score in low-grade microvascular inflammation-associations with transplant glomerulopathy and graft loss. Nephrol Dial Transplant 2019;34:166-74.
4.    Kozakowski N, Eskandary F, Herkner H, et al. Diffuse Extent of Peritubular Capillaritis in Late Antibody-Mediated Rejection: Associations With Levels of Donor-Specific Antibodies and Chronic Allograft Injury. Transplantation 2017;101:e178-e87.