Results of Kidney Transplantation from High–Terminal Creatinine Donors and the Role of Time-Zero Biopsy

Lin, Niu; Yang, An Hang; King, Kristen L.; Wu, Tingkun; Yang, Wancai; Loong, Che‐Chuan

doi:10.1016/j.transproceed.2010.08.053

Cited by 19 publications

(12 citation statements)

References 18 publications

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“…Whether these thresholds were prespecified or selected after examining the data and thereby potentially biasing the results was not indicated. Several single‐center studies reported associations between different thresholds of GS and GF, but several other studies did not . None indicated whether the thresholds of GS were prespecified or resulted from sampling several different thresholds.…”

Section: Resultsmentioning

confidence: 99%

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

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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.

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Section: Resultsmentioning

confidence: 99%

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

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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.

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“…Previous studies investigating donors with higher terminal creatinine are contradictory. One study reported similar 5-year graft survival rates for recipients of donors with higher and lower terminal creatinine, 30 whereas another study reported statistically significant decrease in graft survival for aged donors (≥55 years) with lower serum creatinine (<80 mL/min). 31 …”

Section: Discussionmentioning

confidence: 99%

Donor Characteristics of Pancreas Transplantation in Australia and New Zealand: A Cohort Study 1984-2014

Peng

Kelly

Mulley

et al. 2016

Transplantation Direct

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BackgroundThe aim of this study was to audit the characteristics of pancreas donors over time in Australia and New Zealand. Pancreas transplantation was introduced in Australian and New Zealand in 1984.MethodsWe analyzed data from the Australia and New Zealand Islet and Pancreas Transplant Registry, 1984 to 2014. We investigated the variation of donor characteristics of sex, age, body mass index, smoking status, blood group, multiple organ donation, cytomegalovirus status, terminal creatinine, hypertension, and cause of death for pancreas transplantation over time. We used χ2 test (Fisher test when necessary) or analysis of variance to test difference for categorical or continuous characteristics, respectively.ResultsThere were 628 pancreas donors from 1984 to 2014. Donor body mass index (from 21.9 to 24.0, P < 0.001) and age (from 23.9 to 28.5, P = 0.02) have both increased while terminal creatinine has decreased (86.3 to 73.3, P = 0.01) from 1995 to 2014. In the meantime, the proportions of donors with hypertension (from 19% to 1%, P < 0.001) and who were smokers (from 54% to 15%, P < 0.001) have decreased. Profile of cause of donor death has also changed over time (P = 0.06) with increase in cerebral hypoxia/ischemia (from 3% to 17%) and reductions in intracranial hemorrhage (27% to 13%).ConclusionsMany donor characteristics have changed over time. The most significant changes appear to reflect changes in the general population, rather than changes in donor selection.

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Results of Kidney Transplantation from High–Terminal Creatinine Donors and the Role of Time-Zero Biopsy

Cited by 19 publications

References 18 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

Donor Characteristics of Pancreas Transplantation in Australia and New Zealand: A Cohort Study 1984-2014

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