News: Automated classification system simplifies diagnostic assessment for transplant rejection, study says

The use of a kidney allograft diagnostic automation system stopped 40% of misdiagnoses of allograft rejection from occurring, according to new research published in Nature Medicine. The study also showed improvement in patient risk stratification in adult and pediatric kidney transplant recipients through the online, user-friendly system. The system classified a total of 57% of the borderline cases to a higher grade of rejection, likely triggering additional immunosuppressive treatments, Medscape Medical News reported.

For the study, 4,409 biopsies from 3,054 patients at 20 transplant referral centers in Europe and North America were reviewed, identifying rejections not identified by pathologists as well as nonrejection cases identified as rejections. Use of this system resulted in reclassification of about 30% of cases as antibody-mediated rejection and 54% as T cell-mediated rejection. Roughly 7% of biopsies diagnosed as nonrejection were reclassified as rejection.

In evaluating clinical outcomes of these reclassifications, patients diagnosed as nonrejection by a pathologist but reclassified by the automated system as rejection showed significantly worse graft survival in comparison to those that stayed as nonrejection. This suggests that the automated system’s corrected diagnosis was accurate. Likewise, those diagnosed as rejection but reclassified as nonrejection showed excellent graft survival.

While this system works to prevent misclassification, there may be clinical factors that override its automated decision-making, according to Alexandre Loupy, MD, PhD, of the Paris Institute for Transplantation and Organ Regeneration and senior author of the study.

“It is important to note that this tool does not consider the patient's clinical history, which can sometimes cause the pathologist to decide on a rejection diagnosis without meeting all the criteria of the Banff classification,” Loupy told Medscape Medical News.

The automated system has been validated by international transplant societies including the American Society of Transplantation and European Society for Organ Transplantation, and is available for free to the medical community as an open-access application that will be updated on a regular basis.

Editor’s note: To read Medscape Medical News’ coverage of this story, click here. To read the study, click here.