Comparison Between Clinical and Histopathological Scoring in Cadaveric Kidney Transplantation and Its Correlation With Posttransplant Evolution

Re, Luis; Cicora, Federico; Petroni, J.; Goldberg, J.; Rial, M; Casadei, Domingo

doi:10.1016/j.transproceed.2006.02.042

Cited by 13 publications

(10 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Four of eight studies reported an association with GF , while four others did not find an association with GF . Of three studies that 0 used morphometry to quantitate chronic injury, two reported an association with GF , while one did not .…”

Section: Resultsmentioning

confidence: 88%

“…Ortiz et al showed a correlation between CADI score and serum creatinine at 6 months and 2 years, but not at 1 year. However, four other studies found no association between histologic scores and graft function .…”

Section: Resultsmentioning

confidence: 90%

“…For the most part, histologic scores have not correlated with DGF. Three unadjusted studies found no association between the Remuzzi or CADI scores and DGF , while two unadjusted studies reported an association with a scoring system and DGF . Similarly, most studies using multivariate models found no associations between histologic scores and DGF .…”

Section: Resultsmentioning

confidence: 94%

See 2 more Smart Citations

The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review

Wang

Wetmore

Crary

et al. 2015

American Journal of Transplantation

137

175

View full text Add to dashboard Cite

Despite a growing organ shortage in the United States, many deceased donor kidneys removed for transplantation are discarded. Kidney biopsy findings often play a role in these discards, although it is not clear whether biopsies reliably inform acceptance decisions. Therefore, we carried out a systematic review of the medical literature on the utility of both procurement and implantation biopsies for predicting posttransplant outcomes. Between January 1, 1994 and July 1, 2014, 47 studies were published in the English language literature that examined the association between pretransplant donor biopsy findings from 50 or more donors (with more than half being from deceased donors) and either posttransplant graft failure, delayed graft function, or graft function. In general, study quality was poor. All were retrospective or did not indicate if they were prospective. Results were heterogeneous, with authors as often as not concluding that biopsy results did not predict posttransplant outcomes. The percent glomerular sclerosis was most often examined, and failed to predict graft failure in 7 of 14 studies. Of 15 semiquantitative scoring systems proposed, none consistently predicted posttransplant outcomes across studies. Routine use of biopsies to help determine whether or not to transplant a kidney should be reexamined.

show abstract

Section: Resultsmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 94%

See 1 more Smart Citation

The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review

Wang

Wetmore

Crary

et al. 2015

American Journal of Transplantation

137

175

View full text Add to dashboard Cite

show abstract

“…These biopsies have usually been paraffin embedded, carefully stained, and interpreted by renal pathologists. Different scoring systems have been used to assess the amount of chronic damage (11,15,23,27,29,32,33,39,40). Morphometry has also been used to determine the amount of chronic damage in the transplanted kidney as accurately as possible (23,25,32).…”

Section: Discussionmentioning

confidence: 99%

The Role of Procurement Biopsies in Acceptance Decisions for Kidneys Retrieved for Transplant

Kasiske

Stewart

Bista³

et al. 2014

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives 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.Design, setting, participants, & measurements 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%).Results 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%615.3%, 9.0%66.6%, and 5.0%65.9%, 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.Conclusions Routine use of biopsies could lead to unnecessary kidney discards.

show abstract

“…Ibernon et al [22] found that histologic and functional parameters are associated with the donor graft function after 3 months. However, Cicora et al [23] compared a donor score with histology and found that only clinical data were related with graft function. Inversely, Snoeijs et al [24] conducted a similar comparison and found that histologic data were the only ones able to predict renal graft function.…”

Section: Discussionmentioning

confidence: 99%

Pretransplant Biopsy in Expanded Criteria Donors: Do We Really Need It?

Tavares-da-Silva¹,

Oliveira²,

Castelo³

et al. 2014

Transplantation Proceedings

View full text Add to dashboard Cite

Introduction. Renal transplantation is the best treatment for end-stage renal disease, including when using expanded criteria donors (ECD) kidneys. However, these suboptimal kidneys should be evaluated rigorously to meet their usefulness. Opinions differ about the best way to evaluate them. Materials and Methods. We retrospectively reviewed kidneys from ECD harvested by a single academic institution between January 2008 and September 2013. Needle biopsies were performed at the time of the harvest when considered relevant by the transplant team. Two pathologists where responsible for their analysis; the Remuzzi classification has been used in all cases. Results. We evaluated 560 ECD kidneys. Biopsies were made in 197 (35.2%) organs, 20 of which were considered not usable and 36 good only for double transplantation. Sixty-three kidneys (11.3%) were discarded by the transplant team based on the biopsy result and clinical criteria. Donors who underwent a biopsy were older (P < .001) and had a worse glomerular filtration rate (GFR; P ¼ .001). Comparing donors approved and rejected by the biopsy, the rejected donors were heavier (P ¼ .003) and had a lower GFR (P ¼ .002). Cold ischemia time was longer for the biopsy group (P < .001). Regarding graft function, the biopsy overall score correlated with the transplant outcome in the short and long term. Separately, glomeruli and interstitium scores were correlated with recipient's GFR in the earlier periods (3 months; P ¼ .025 and .037), and the arteries and tubules correlated with GFR in the longer term (at 3 years P ¼ .004 and .010). Conclusion. The decision on the usability of ECD grafts is complex. At our center, we chose a mixed approach based on donor risk. Low-risk ECD do not require biopsy. In more complex situations, especially older donors or those with a lower GFR, prompted a pretransplant biopsy. The biopsy results proved to be useful as they relate to subsequent transplant outcomes, thereby allowing us to exclude grafts whose function would most probably be less than optimal.

show abstract

Comparison Between Clinical and Histopathological Scoring in Cadaveric Kidney Transplantation and Its Correlation With Posttransplant Evolution

Cited by 13 publications

References 4 publications

The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review

The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review

The Role of Procurement Biopsies in Acceptance Decisions for Kidneys Retrieved for Transplant

Pretransplant Biopsy in Expanded Criteria Donors: Do We Really Need It?

Contact Info

Product

Resources

About