Biomarker implementation: Evaluation of the decision‐making impact of CXCL10 testing in a pediatric cohort

Background Children are at high risk for subclinical rejection, and kidney biopsy is currently used for surveillance. Our objective was to test how novel rejection biomarkers such as urinary CXCL10 may influence clinical decision‐making to indicate need for a biopsy. Methods A minimum dataset for st...

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Bibliographic Details
Published in:Pediatric transplantation 2021-05, Vol.25 (3), p.e13908-n/a
Main Authors: Lamarche, Caroline, Sharma, Atul K., Goldberg, Aviva, Wang, Li, Blydt‐Hansen, Tom D.
Format: Article
Language:English
Subjects:
acute rejection
Adolescent
biomarker
Biomarkers
Biomarkers - urine
Biopsy
Chemokine CXCL10 - urine
Child
Clinical Decision-Making
Cohort Studies
CXCL10
CXCL10 protein
Decision making
Graft Rejection - pathology
Graft Rejection - urine
Humans
Information processing
Kidney Transplantation
Kidney transplants
Nephrology
pediatric kidney transplantation
Pediatrics
Probability
Risk Assessment
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Summary:Background Children are at high risk for subclinical rejection, and kidney biopsy is currently used for surveillance. Our objective was to test how novel rejection biomarkers such as urinary CXCL10 may influence clinical decision‐making to indicate need for a biopsy. Methods A minimum dataset for standard decision‐making to indicate a biopsy was established by an expert panel and used to design clinical vignettes for use in a survey. Pediatric nephrologists were recruited to review the vignettes and A) estimate rejection risk and B) decide whether to biopsy; first without and then with urinary CXCL10/Cr level. Accuracy of biopsy decisions was then tested against the biopsy results. IRA was assessed by Fleiss Kappa (κ) for binary choice and ICC for probabilities. Results Eleven pediatric nephrologists reviewed 15 vignettes each. ICC of probability assessment for rejection improved from poor (0.28, P 
ISSN:1397-3142
1399-3046
DOI:10.1111/petr.13908