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

Abstract

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.

Apolipoprotein L1 Gene Variants in Deceased Organ Donors Are Associated With Renal Allograft Failure

“…Further, rates of discard of recovered kidneys are on the rise and identification of adverse characteristics may increase the rate. (41) In contrast, identification of organs at risk for early failure should result in more appropriate organ allocation, narrowing currently observed racial disparity in allograft outcomes. (19) We anticipate that improved stratification of organs would increase confidence in the clinical assessment of organ quality, and improve the utilization of all organs, with and without APOL1 -risk variants.…”

The weekend effect alters the procurement and discard rates of deceased donor kidneys in the United States

“…Each year over 5,000 people die waiting for a kidney transplant while annually, nearly 2,700 kidneys that are procured for transplantation are subsequently discarded (11). This high rate of discard is concerning especially given the worsening organ shortage in the United States (U.S.), yet the factors contributing to organ discard remain poorly understood.…”

Renal Allograft Fibrosis: Biology and Therapeutic Targets

“…IF/TA is detectable in about 40% of kidney allografts at 3-6 months (6,7) and increases to about 65% at 2 years (8). IF/TA is a non-specific lesion induced by various immune and non-immune injuries to the graft (9,10) and an independent risk factor for late graft loss, particularly in grafts from expanded criteria donors, irrespective of whether a specific disease was diagnosed in the allograft or not (11)(12)(13)(14)(15). However, ''IF/TA'' should only be diagnosed if the underlying etiology of fibrosis and tubular atrophy is not clear (5).…”