ArticleVirchows Archiv : an international journal of pathology2025
Instant confocal histology for the evaluation of kidney transplant procurement biopsies.
Article in Virchows Archiv : an international journal of pathology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Prognostic outcome models might help to minimise the discard rates of renal transplants from deceased donors. To this end, we published 2-Step Scores for both delayed graft function and transplant loss with optional histology. With conventional paraffin PAS histology taking at least 3 h excluding transport time, we tested whether fast, mobile confocal histology with portable VivaScope® 2500 systems might offer a viable and more rapid alternative. After omitting 17 biopsies with less than 12 glomeruli and 1 artery, we collected 14 0-h and 16 renal transplant indication (Tx) biopsies for a combined cohort. All biopsies were scanned in less than 10 min with a VivaScope® 2500, rendering pseudo-HE images, and then underwent our regular paraffin work-up. Banff Lesion Scores ct and cv were assessed on the granular ordinal scale and binary as (ct ≤ 1 vs. ct ≥ 2 and cv ≤ 2 vs. cv3) together with the number of glomeruli as used in the previously published 2-Step Scores in a blinded fashion by an expert nephropathologist on the paraffin sections (P) and VivaScope® 2500 scans (V). Additionally, we examined the ratio of globally sclerotic glomeruli. Correlation and mixed effects linear regressions, as well as Fleiss' kappa statistics, comparing P and V on the combined cohort were applied, supplemented with Bland-Altman statistics providing limits of agreement. Between P and V, granular Banff ct correlated with a kappa of 0.513 (p = 8.38e-05) and a Kendall's W of 0.706 (p = 0.0694) on the combined cohort; binary Banff ct correlated with a kappa of 0.869 (p = 1.92e-06). We had to exclude two more biopsies in which no artery was found in the scanning plane in V. Granular Banff cv correlated with a kappa of 0.109 (p = 0.345) and a W of 0.677 (p = 0.103) between P and V on the combined cohort and binary Banff cv with a kappa of 0.24 (p = 0.204). The total number of glomeruli correlated between P and V with an R of 0.75 (p = 2.3e-06), the number of globally sclerotic glomeruli with an R of 0.82 (p = 4.1e-08), and the ratio thereof with an R of 0.86 (p = 8.6e-10). Instant, decentralised VivaScope® 2500 histology might deliver Banff ct and the number of glomeruli with sufficient accuracy for the 2-Step Scores to predict the risk of delayed graft function and 1-year death-censored transplant loss in deceased heart-beating donors. In contrast, VivaScope® 2500 assessment of Banff cv might not be accurate enough for use in 2-Step Scores.
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