Allograft Duodenal Cuff Biopsy as Surrogate in Evaluation of Pancreatic Transplant Rejection – A Multicenter Data Effort
Notice bibliographique
Résumé
Introduction Accurate diagnosis of pancreas rejection is required for early, targeted treatment and function preservation. Pancreas biopsy considered the gold standard presents with sampling issues and perceived procedural risks that limit its widespread use. Evaluation of the graft duodenal cuff, through upper endoscopy in intestine drained pancreas transplants has been proposed as a surrogate of pancreas biopsy but the utility of this approach has not been tested. In this multicenter effort we retrospectively evaluated pancreas and duodenal tissues collected simultaneously to correlate findings of acute cell-mediated rejection (ACR) in these two organs and offer interpretation of duodenal cuff biopsies as a potential diagnostic surrogate for its corresponding pancreas allograft. Materials and Methods A total of 88 cases were evaluated retrospectively from allograft pancreas performed between 1995 and 2015, with incidentally or intentionally obtained duodenal cuff mucosa from 11 reference tranplant centers in the North and South Americas, E.U. and U.K. These cases were re-analyzed and graded for ACR. Sixteen cases were excluded due to inadequate pancreas or duodenal sample, possible non-rejection biopsy findings or samples that were not simultaneously obtained. Of the remaining 72 cases, 50 were biopsies and 22 were explant cases. The cases were graded according to the Banff schema for grading pancreas allograft rejection (Drachenberg et al 2008) and from the schema for histologic grading of small intestine allografts (Wu et al 2008). Results Of the 72 cases, 20 cases showed a diagnosis of rejection. All 20 (100%) cases showed rejection in both pancreas and duodenal tissue. Fifty eight cases (80.5%) showed results that were concordant for a final diagnosis of rejection/suspicious for rejection or no evidence of rejection. Of the 14 (19.5%) cases that showed complete discordance (either suspected or diagnostic for rejection in pancreas but not duodenum or suspected or diagnostic for rejection in duodenum but not pancreas) 2 cases (2.7%) showed findings of rejection in the duodenum but not pancreas and 12 cases (16.6%) showed findings of rejection in pancreas but not in duodenum. Discussion In this cohort with simultaneous histological evaluation of pancreas parenchyma and graft duodenal cuff, a diagnosis of ACR in the duodenum showed a positive predictive value of 100% for pancreas ACR. Therefore evaluation of the duodenal cuff appears to be a useful surrogate in the absence of pancreas parenchyma in this setting. On the other hand, absence of rejection in the duodenum did not totally exclude rejecion in the pancreas, with a negative predictive value of 83%. Results that were graded as indeterminate (suspicious for) rejection in duodenum were not reliable and had both low PPV and NPV for pancreas rejection. Our results are encouraging and indicate the potential value of duodenal cuff evaluation, as well as the need for additional studies.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,042 | 0,031 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,004 | 0,004 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».