The role of procurement biopsies in acceptance decisions for kidneys retrieved for transplant

• Published in: Clinical journal of the American Society of Nephrology Vol. 9; no. 3; pp. 562 - 571
• Main Authors: Kasiske, Bertram L, Stewart, Darren E, Bista, Bipin R, Salkowski, Nicholas, Snyder, Jon J, Israni, Ajay K, Crary, Gretchen S, Rosendale, John D, Matas, Arthur J, Delmonico, Francis L
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.03.2014
• Subjects: Biopsy - standards; Donor Selection - methods; Donor Selection - standards; Graft Survival; Health Services Accessibility; Humans; Kidney - pathology; Kidney Transplantation - adverse effects; Kidney Transplantation - methods; Kidney Transplantation - standards; Logistic Models; Odds Ratio; Original; Predictive Value of Tests; Proportional Hazards Models; Quality of Health Care; Retrospective Studies; Risk Factors; Time Factors; Tissue and Organ Procurement - methods; Tissue and Organ Procurement - standards; Tissue Donors - supply & distribution; Treatment Outcome; Waiting Lists
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.07610713

There is a shortage of kidneys for transplant, and many patients on the deceased donor kidney transplant waiting list would likely benefit from kidneys that are currently being discarded. In the United States, the most common reason given for discarding kidneys retrieved for transplant is procurement biopsy results. This study aimed to compare biopsy results from discarded kidneys with discard attributed to biopsy findings, with biopsy results from comparable kidneys that were successfully transplanted. In this retrospective, observational, case-control study, biopsy reports were examined from 83 kidneys discarded in 2010 due to biopsy findings (cases), 83 contralateral transplanted kidneys from the same donor (contralateral controls), and 83 deceased donors randomly matched to cases by donor risk profile (randomly matched controls). A second procurement biopsy was obtained in 64 of 332 kidneys (19.3%). The quality of biopsy reports was low, with amounts of tubular atrophy, interstitial inflammation, arteriolar hyalinosis, and acute tubular necrosis often not indicated; 69% were wedge biopsies and 94% used frozen tissue. The correlation between first and second procurement biopsies was poor; only 25% of the variability (R(2)) in glomerulosclerosis was explained by biopsies being from the same kidney. The percentages of glomerulosclerosis overlapped substantially between cases, contralateral controls, and randomly matched controls: 17.1%±15.3%, 9.0%±6.6%, and 5.0%±5.9%, respectively. Of all biopsy findings, only glomerulosclerosis>20% was independently correlated with discard (cases versus contralateral controls; odds ratio, 15.09; 95% confidence interval, 2.47 to 92.41; P=0.003), suggesting that only this biopsy result was used in acceptance decisions. One-year graft survival was 79.5% and 90.7% in contralateral and randomly matched controls, respectively, versus 91.6% among all deceased donor transplants in the Scientific Registry of Transplant Recipients. Routine use of biopsies could lead to unnecessary kidney discards.