Pathomic analysis of 5-year surveillance biopsies as predictors of kidney allograft loss.

This study aimed to assess whether various pathomic features in automatically segmented glomeruli and tubules were associated with death-censored graft loss in kidney transplant recipients. We studied 906 patients who were transplanted between 2000 and 2013, returned to Mayo Clinic for a 5-year surveillance biopsy, and had available subsequent follow-up. Banff scores were obtained from the pathology reports and clinical characteristics from the patients' charts. A multicompartment segmentation model segmented nonsclerotic glomeruli and tubules, and within these compartments, morphometric and textural (pathomic) features were computed. There were 70 death-censored graft losses that occurred during the 5 years of follow-up, and Cox models were used to assess the risk of death-censored graft failure with all Banff scores, with 2 composite pathomic features (glomeruli and tubules), and with Banff scores and pathomic features combined. The composite pathomic score model had similar performance to the Banff score model (c-statistics 0.845 vs 0.823, P = .47). A model combining the Banff scores and pathomic scores showed the best performance (c-statistic 0.897). We conclude that multicompartment segmentation models can identify pathomic features which can complement Banff scoring and are associated with future graft loss.