Invited letter in response to: “Is the kidney donor profile index (KDPI) universal or UNOS-specific?”

Ruggenenti, Piero

doi:10.1111/ajt.14652

Cited by 7 publications

(7 citation statements)

References 5 publications

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“…In line with the limited discriminative power regarding graft failure very high KDPI kidneys may reveal acceptable outcomes (21)(22)(23)(24). Another group showed 5-year graft survival of 91% using kidneys with KDPI score of 97% as dual transplants, highlighting that besides KDRI, nephron mass plays a major role with respect to graft survival (14,25). A further a critical issue when using KDRI/KDPI is Hepatitis C virus (HCV) status having the largest contribution to KDPI (KDRI b coefficient 1/4.24; "Xb" component 1/4.24).…”

Section: Clinical Scoresmentioning

confidence: 99%

Assessment of Organ Quality in Kidney Transplantation by Molecular Analysis and Why It May Not Have Been Achieved, Yet

et al. 2020

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Section: Clinical Scoresmentioning

confidence: 99%

Assessment of Organ Quality in Kidney Transplantation by Molecular Analysis and Why It May Not Have Been Achieved, Yet

et al. 2020

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“…Overall, data from multiple groups [19] converge to indicate that kidneys from donors older than 60 years with a KDPI higher than 85% can be used safely, provided that the kidneys are selected and allocated on the basis of pretransplant histologic findings [22]. It has been estimated that an allocation strategy based on pretransplant donor biopsy would increase by over 20% the incidence of renal transplants from donors with marginal KDPI (80-100), which would translate into an overall increase of 4% considering the entire pool of donors [21].…”

Section: Quantifying Nephron Mass To Decide Organ Suitabilitymentioning

confidence: 99%

Making Procurement Biopsies Important Again for Kidney Transplant Allocation

Angeletti

Cravedi²

2019

Nephron

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Context: Results of procurement biopsies often drive the decision to discard kidneys from deceased donors with advanced age or comorbidities. However, the criteria to perform, process, and score procurement graft biopsies are not standardized. Subject of Review: A recent retrospective, single-center study by Carpenter et al. [Clin J Am Soc Nephrol 2018; 13: 1876–1885] compared the scores obtained from 270 consecutive frozen kidney sections of biopsies at time of procurement with those of paraffin-embedded sections of biopsies at reperfusion and the correlation of both biopsy scores with graft survival. In 116 kidneys, procurement biopsies were repeated, allowing to test the reproducibility of this technique. Procurement biopsies were poorly reproducible, did not correlate with scores obtained with paraffin-embedded reperfusion biopsies, and were not significantly associated with transplant outcomes, while reperfusion biopsies provided an excellent prediction of graft survival. Based on these findings, the authors suggest “an urgent need to reexamine the role of procurement biopsies during allocation given their high resource requirements and association with discards.” Second Opinion: Carpenter’s paper is important because it emphasizes the crucial role of correct histological evaluation of kidney grafts to accurately predict their survival. In this study, procurement biopsies were frozen and read by on-call pathologists, often with no specific training in renal pathology, while reperfusion sections were paraffin embedded and scored by experienced renal pathologists at Columbia University, New York, NY, USA. This methodological difference per se represents an obvious explanation for the poor concordance between the 2 assessments. Use of wedge biopsies in procurement samples versus core-needle samples in reperfusion biopsies may further account for the discrepancies between scores even in seemingly objective measurements, such as the percentage of glomerulosclerosis. Therefore, these data should not mislead us regarding the importance of procurement biopsies to define organ suitability for transplantation. Rather, they should prompt more studies aimed at optimizing the strategies to score these samples properly for optimal organ allocation.

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“…The question of UNOS specificity of the KDPI is examined in a recent study by Ruggenenti et al[95]. According to the author, the difference in ethnicity may only partially explain the different results and the different discard rates of UNOS and several European studies[96].…”

Section: Ecd-kdri-kdpimentioning

confidence: 99%

Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best?

Salvadori¹,

Tsalouchos²

2019

WJT

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Organ shortage represents one of the major limitations to the development of kidney transplantation. To increase the donor pool and to answer the ever increasing kidney request, physicians are recurring to marginal kidneys as kidneys from older donors, from hypertensive or diabetic donors and from non-heart beating donors. These kidneys are known to have frequently a worse outcome in the recipients. To date major problem is to evaluate such kidneys in order to use or to discard them before transplantation. The use of such kidneys create other relevant question as whether to use them as single or dual transplant and to allocate them fairly according transplant programs. The pre-transplant histological evaluation, the clinical evaluation of the donor or both the criteria joined has been used and according the time each criterion prevailed over the others. Aim of this review has been to examine the advantages and the drawbacks of any criterion and how they have changed with time. To date any criterion has several limitations and several authors have argued for the development of new guidelines in the field of the kidney evaluation for transplantation. Several authors argue that the use of omic technologies should improve the organ evaluation and studies are ongoing to evaluate these technologies either in the donor urine or in the biopsies taken before transplantation.

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Invited letter in response to: “Is the kidney donor profile index (KDPI) universal or UNOS-specific?”

Cited by 7 publications

References 5 publications

Assessment of Organ Quality in Kidney Transplantation by Molecular Analysis and Why It May Not Have Been Achieved, Yet

Assessment of Organ Quality in Kidney Transplantation by Molecular Analysis and Why It May Not Have Been Achieved, Yet

Making Procurement Biopsies Important Again for Kidney Transplant Allocation

Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best?

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