Manuela Garofalo

Donor Quality Scoring Systems and Early Renal Function Measurements in Kidney Transplantation

Over the last years, an extensive improvement in the use of non-standard kidney allografts from deceased donors has been observed due to a chronic scarcity in the number of available donors. However, use of these donors seems to give worse results, higher delayed graft function (DGF) and rejection rates and briefer graft survivals. Nevertheless, a standardized definition of non-standard donor is still under debate. On these grounds, several studies have focalized on the importance of events immediately before or early post-transplant in determining allograft outcome: introduction of scores based on peri-operative features capable to predict graft function may yield huge implications for organ allocation policies, as well as for immediate and late clinical and immunological management of recipients. In fact, if pre-KT information could accurately predict suboptimal early graft function, the success of various mechanical, immunosuppressive and organ allocation strategies may be improved. The aim of this review is to analyze the different preand post-transplant score systems, detecting their role in the clinical practice and comparing them in terms of prognostic ability.

Automated Intelligent Microscopy for the Recognition of Decoy Cells in Urine Samples of Kidney Transplant Patients

BACKGROUND BK virus (BKV)-associated nephropathy is definitely involved in allograft failure after kidney transplant. Thus, the need for an early control of viral reactivation in immunocompromised patients is well established. Determination of urinary release of decoy cells (DC) and BK viral load in plasma and urine by polymerase chain reaction (PCR) usually precedes renal biopsy. The aim of the study is to assess viral reactivation by BKV-DNA PCR and DC detection in urinary sediment using automated intelligent microscopy. METHODS Seventy-eight kidney transplant patients were analyzed for the presence of plasma BKV-DNA by quantitative TaqMan real-time PCR. Additionally, automated intelligent microscopy was used for urine sediment analysis, allowing to count cells with decoy feature, confirmed by phase contrast microscopic review. RESULTS Plasma BKV-DNA PCR was detected in 14 (17.9%) patients. DC were identified in 19 (24.3%) urine sediments by automated analyzers and confirmed by microscopic observation. Two patients were BKV-DNA-positive/DC-negative; conversely, 7 subjects were DC-positive/BKV-DNA-negative. CONCLUSIONS Plasma quantification of BK viral load is currently the best noninvasive method for the detection of viral reactivation. Nevertheless, automated methods to screen for the presence of DC in urine could facilitate early BK virus replication diagnosis and patient follow-up by quantitative and visual results.