ORCID Profile
0000-0002-2300-0287
Current Organisation
Westmead Hospital
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Publisher: Elsevier BV
Date: 09-2020
DOI: 10.1111/AJT.15898
Publisher: Elsevier BV
Date: 07-2022
Publisher: Elsevier BV
Date: 08-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-06-2020
DOI: 10.2215/CJN.13611119
Abstract: The published tissue adequacy requirement of kidney medulla for BK virus allograft nephropathy diagnosis lacks systematic verification and competes against potential increased procedural risks from deeper s ling. We evaluated whether the presence of kidney medulla improved the diagnostic rate of BK nephropathy in 2244 consecutive biopsy s les from 856 kidney transplants with detailed histologic and virologic results. Medulla was present in 821 s les (37%) and correlated with maximal core length ( r =0.35 P .001). BK virus allograft nephropathy occurred in 74 (3% overall) but increased to 5% (42 of 821) with medulla compared with 2% (32 of 1423) for cortical s les ( P .001). Biopsy medulla was associated with infection after comprehensive multivariable adjustment of confounders, including core length, glomerular number, and number of cores (adjusted odds ratio, 1.81 95% confidence interval, 1.02 to 3.21 P =0.04). In viremic cases ( n =275), medulla was associated with BK virus nephropathy diagnosis (39% versus 19% for cortex P .001) and tissue polyomavirus load (Banff polyomavirus score 0.64±0.96 versus 0.33±1.00 P =0.006). Biopsy medulla was associated with BK virus allograft nephropathy using generalized estimating equation (odds ratio, 2.04 95% confidence interval, 1.05 to 3.96 n =275) and propensity matched score comparison (odds ratio, 2.24 95% confidence interval, 1.11 to 4.54 P =0.03 for 156 balanced pairs). Morphometric evaluation of Simian virus 40 large T immunohistochemistry found maximal infected tubules within the inner cortex and medullary regions ( P .001 versus outer cortex). Active BK virus replication concentrated around the corticomedullary junction can explain the higher detection rates for BK virus allograft nephropathy with deep s ling. The current adequacy requirement specifying targeting medulla can be justified to minimize a missed diagnosis from unders ling.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Elsevier BV
Date: 07-2022
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Brian Nankivell.