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基于班夫人类器官移植基因检测板的肾移植排斥反应分子诊断:一项多中心国际研究。

Molecular diagnosis of kidney allograft rejection based on the Banff Human Organ Transplant gene panel: A multicenter international study.

作者信息

Zielinski Dina, Goutaudier Valentin, Sablik Marta, Divard Gillian, Aubert Olivier, Piedrafita Alexis, Mezine Fariza, Dagobert Jessy, Certain Anais, Robin Blaise, Gueguen Juliette, Rabant Marion, Duong van Huyen Jean-Paul, Sannier Aurélie, Randoux-Lebrun Christine, Maanaoui Mehdi, Lionet Arnaud, Gibier Jean-Baptiste, Gnemmi Viviane, Le Quintrec Moglie, Chauveau Bertrand, Vermorel Agathe, Couzi Lionel, Bestard Oriol, Elias Michelle, Louis Kevin, Rosales Ivy A, Smith R Neal, Kung Vanderlene L, Anglicheau Dany, Legendre Christophe, Del Bello Arnaud, Huang Edmund, Adam Benjamin, Kamar Nassim, Colvin Robert B, Mengel Michael, Lefaucheur Carmen, Loupy Alexandre

机构信息

Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France.

Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France; Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.

出版信息

Am J Transplant. 2025 Aug;25(8):1631-1642. doi: 10.1016/j.ajt.2025.04.025. Epub 2025 May 8.

Abstract

Transcriptomic analysis of kidney biopsies has demonstrated the potential to improve diagnosis of allograft rejection. Here, we developed a molecular assessment of antibody-mediated rejection (AMR) and T cell-mediated rejection (TCMR) based on the Banff Human Organ Transplant consensus gene panel. Expression assays of formalin-fixed paraffin-embedded kidney biopsies from well-phenotyped cohorts were used to develop prediction models for AMR and TCMR and an automated report of gene expression-based diagnosis. The study population consisted of 950 kidney allograft biopsies from 10 transplantation centers in Europe and North America. The development cohort included 664 renal allograft biopsies split into a training (n = 537) and test set (n = 127), and 2 external validation cohorts (n = 286). We performed gene selection using regularized regression and developed several different base models based on Banff Human Organ Transplant expression data, which were combined into a single ensemble model for each rejection diagnosis. Model performance was assessed in the test set and the 2 external validation cohorts, showing good discriminative abilities (respective areas under the precision-recall curve: AMR = 0.811, 0.891, and 0.832 and TCMR = 0.736, 0.810, and 0.782). We identified challenging biopsies with histology below diagnostic thresholds for which gene expression-based probability can refine rejection diagnosis. This automated molecular diagnostic system shows potential for improving kidney allograft rejection diagnosis in routine practice and clinical trials.

摘要

肾活检的转录组分析已显示出改善同种异体移植排斥反应诊断的潜力。在此,我们基于班夫人类器官移植共识基因面板开发了一种抗体介导排斥反应(AMR)和T细胞介导排斥反应(TCMR)的分子评估方法。使用来自表型明确队列的福尔马林固定石蜡包埋肾活检组织的表达分析来开发AMR和TCMR的预测模型以及基于基因表达的诊断自动化报告。研究人群包括来自欧洲和北美的10个移植中心的950例肾移植活检组织。开发队列包括664例肾移植活检组织,分为训练集(n = 537)和测试集(n = 127),以及2个外部验证队列(n = 286)。我们使用正则化回归进行基因选择,并基于班夫人类器官移植表达数据开发了几种不同的基础模型,将其组合成每个排斥反应诊断的单个集成模型。在测试集和2个外部验证队列中评估模型性能,显示出良好的判别能力(精确召回曲线下的相应面积:AMR = 0.811、0.891和0.832,TCMR = 0.736、0.810和0.782)。我们识别出组织学低于诊断阈值的具有挑战性的活检组织,基于基因表达的概率可以完善排斥反应诊断。这种自动化分子诊断系统在常规实践和临床试验中显示出改善肾移植排斥反应诊断的潜力。

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