New Nature Medicine Article From Dr. Eno Hysi Reports on Imaging of Kidney Transplant Quality

MBP faculty member Dr. Eno Hysi and his clinical collaborators at St. Michael’s Hospital have published a seminal study in Nature Medicine on a novel quantitative ultrasound imaging technique that assess the fibrotic burden of transplanted kidneys. Entitled: “A first-in-human study of quantitative ultrasound to assess transplant kidney fibrosis”, the paper reports evidence that this enhanced ultrasound algorithm, renal H-scan, can accurately measure the fibrotic content of kidneys and associates with post-transplant renal function. Biopsy-based estimates, the current gold standard, do not predict the chronic renal damage that is induced by fibrosis due to its sampling bias and very small volume. This work was also involved collaborators from Toronto Metropolitan University and the University of Rochester and was recently featured by Global News.

Article abstract
Kidney transplantation is the optimal treatment for renal failure. In the United States, a biopsy at the time of organ procurement is often used to assess kidney quality to decide whether it should be used for transplant. This assessment is focused on renal fibrotic burden, because fibrosis is an important measure of irreversible kidney injury. Unfortunately, biopsy at the time of transplant is plagued by problems, including bleeding risk, inaccuracies introduced by sampling bias and rapid sample preparation, and the need for round-the-clock pathology expertise. We developed a quantitative algorithm, called renal H-scan, that can be added to standard ultrasound workflows to quickly and noninvasively measure renal fibrotic burden in preclinical animal models and human transplant kidneys. Furthermore, we provide evidence that biopsy-based fibrosis estimates, because of their highly localized nature, are inaccurate measures of whole-kidney fibrotic burden and do not associate with kidney function post-transplant. In contrast, we show that whole-kidney H-scan fibrosis estimates associate closely with post-transplant renal function. Taken together, our data suggest that the addition of H-scan to standard ultrasound workflows could provide a safe, rapid and easy-to-perform method for accurate quantification of transplant kidney fibrotic burden, and thus better prediction of post-transplant renal outcomes.