Christopher Lawrence1,2*, Sarah Fluck2, Ananda Manoj2, Meryl Griffiths3 and Sathiya Thiru3
1Transplant Diagnostics, Thermo Fisher Scientific, USA 2Department of Renal Unit, The Lister Hospital, Coreys Mill La, UK 3Department of Histopathology, Addenbrooke’s Hospital, UKFulltext PDF
Establishing the cause of kidney allograft dysfunction is often reliant on biopsy appearances. Despite biennial refinements in the Banff classification there remain challenging issues such as ‘borderline’ for T Cell-Mediated Rejection (TCMR). Recently the Banff classification has introduced the potential for molecular assessment of the troubled kidney transplant. We report two cases of graft dysfunction in which the clinical decision making was potentiated by the Molecular Microscope® Diagnostic System (MMDx), both at indication and follow up biopsy. In the first case a patient with ‘borderline TCMR’ changes by traditional methods was shown to have ‘severe’ TCMR by MMDx and when re-biopsied because the creatinine did not improve MMDx demonstrated resolution of the molecular signals of rejection. Conversely the second case was diagnosed with Banff 1a TCMR by traditional methods, but the MMDx gene transcript analysis showed no rejection. Follow up biopsy showed no rejection by either traditional methods or MMDx and blinded re-reporting of the first biopsy disagreed with the initial histopathology report and agreed with MMDx. In both cases The Molecular Microscope offered certainty when traditional pathology was uncertain and if relied upon has the potential to better guide therapeutic interventions.
Lawrence C, Fluck S, Manoj A, Griffiths M, Thiru S. Analysis of RNA Transcripts by the Molecular Microscope Diagnostic System (MMDx) Can Direct Management after Indication Kidney Transplant Biopsy. J Clin Nephrol Kidney Dis. 2020;5(1):1028..