Procurement Biopsies in the Evaluation of Deceased Donor Kidneys. Academic Article uri icon

Overview

abstract

  • BACKGROUND AND OBJECTIVES: Biopsies taken at deceased donor kidney procurement continue to be cited as a leading reason for discard; however, the reproducibility and prognostic capability of these biopsies are controversial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We compiled a retrospective, single-institution, continuous cohort of deceased donor kidney transplants performed from 2006 to 2009. Procurement biopsy information-percentage of glomerulosclerosis, interstitial fibrosis/tubular atrophy, and vascular disease-was obtained from the national transplant database. Using univariable, multivariable, and time-to-event analyses for death-censored graft survival, we compared procurement frozen section biopsy reports with reperfusion paraffin-embedded biopsies read by trained kidney pathologists (n=270). We also examined agreement for sequential procurement biopsies performed on the same kidney (n=116 kidneys). RESULTS: For kidneys on which more than one procurement biopsy was performed (n=116), category agreement was found in only 64% of cases (κ=0.14). For all kidneys (n=270), correlation between procurement and reperfusion biopsies was poor: overall, biopsies were classified into the same category (optimal versus suboptimal) in only 64% of cases (κ=0.25). This discrepancy was most pronounced when categorizing percentage of glomerulosclerosis, which had 63% agreement (κ=0.15). Interstitial fibrosis/tubular atrophy and vascular disease had agreement rates of 82% (κ=0.13) and 80% (κ=0.15), respectively. Ninety-eight (36%) recipients died, and 56 (21%) allografts failed by the end of follow-up. Reperfusion biopsies were more prognostic than procurement biopsies (hazard ratio for graft failure, 2.02; 95% confidence interval, 1.09 to 3.74 versus hazard ratio for graft failure, 1.30; 95% confidence interval, 0.61 to 2.76), with procurement biopsies not significantly associated with graft failure. CONCLUSIONS: We found that procurement biopsies are poorly reproducible, do not correlate well with paraffin-embedded reperfusion biopsies, and are not significantly associated with transplant outcomes.

authors

  • Carpenter, Dustin
  • Husain, S Ali
  • Brennan, Corey
  • Batal, Ibrahim
  • Hall, Isaac E
  • Santoriello, Dominick
  • Rosen, Raphael
  • Crew, R John
  • Campenot, Eric
  • Dube, Geoffrey K
  • Radhakrishnan, Jai
  • Stokes, M Barry
  • Sandoval, P Rodrigo
  • D'Agati, Vivette
  • Cohen, David J
  • Ratner, Lloyd E
  • Markowitz, Glen
  • Mohan, Sumit

publication date

  • October 25, 2018

Research

keywords

  • Donor Selection
  • Kidney
  • Tissue and Organ Procurement

Identity

PubMed Central ID

  • PMC6302333

Scopus Document Identifier

  • 85058612656

Digital Object Identifier (DOI)

  • 10.2215/CJN.06220617

PubMed ID

  • 30361336

Additional Document Info

volume

  • 13

issue

  • 12