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Reproducibility of deceased donor kidney procurement biopsies

Clinical Journal of the American Society of Nephrology, ISSN: 1555-905X, Vol: 15, Issue: 2, Page: 257-264
2020
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Initial biopsy of deceased donor kidneys not reliable for predicting post-transplant outcomes

Initial biopsies of deceased donor kidneys, also known as procurement biopsies, often provided information that was neither reproducible nor associated with allograft outcomes, according to a recently published study. Therefore, researchers contended that procurement biopsy results should not be the deciding factor as to whether a kidney is suitable for transplant. “Much of our prior work has focu

Article Description

Background and objectives Unfavorable histology on procurement biopsies is the most common reason for deceased donor kidney discard. We sought to assess the reproducibility of procurement biopsy findings. Design, setting, participants, & measurements We compiled a continuous cohort of deceased donor kidneys transplanted at our institution from 1/1/2006 to 12/31/2016 that had at least one procurement biopsy performed, and excluded cases with missing biopsy reports and those used in multiorgan transplants. Suboptimal histology was defined as the presence of advanced sclerosis in greater than or equal to one biopsy compartment (glomeruli, tubules/interstitium, vessels). We calculated k coefficients to assess agreement in optimal versus suboptimal classification between sequential biopsy reports for kidneys that underwent multiple procurement biopsies and used time-to-event analysis to evaluate the association between first versus second biopsies and patient and allograft survival. Results Of the 1011 kidneys included in our cohort, 606 (60%) had multiple procurement biopsies; 98% had first biopsy performed at another organ procurement organization and their second biopsy performed locally. Categorical agreement was highest for vascular disease (k50.17) followed by interstitial fibrosis and tubular atrophy (k50.12) and glomerulosclerosis (k50.12). Overall histologic agreement (optimal versus suboptimal) was k50.15. First biopsy histology had no association with allograft survival in unadjusted or adjusted analyses. However, second biopsy optimal histology was associated with a higher probability of death-censored allograft survival, even after adjusting for donor and recipient factors (adjusted hazard ratio, 0.50; 95% confidence interval, 0.34 to 0.75; P50.001). Conclusions Deceased donor kidneys that underwent multiple procurement biopsies often displayed substantial differences in histologic categorization in sequential biopsies, and there was no association between first biopsy findings and post-transplant outcomes.

Bibliographic Details

Husain, S Ali; King, Kristen L; Batal, Ibrahim; Dube, Geoffrey K; Hall, Isaac E; Brennan, Corey; Stokes, M Barry; Crew, R John; Carpenter, Dustin; Alvarado Verduzco, Hector; Rosen, Raphael; Coley, Shana; Campenot, Eric; Santoriello, Dominick; Perotte, Adler; Natarajan, Karthik; D'Agati, Vivette D; Cohen, David J; Ratner, Lloyd E; Markowitz, Glen; Mohan, Sumit

Ovid Technologies (Wolters Kluwer Health)

Medicine

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