Zero-Time Renal Transplant Biopsies

Abstract

Zero-time kidney biopsies, obtained at time of transplantation, are performed in many transplant centers worldwide. Decisions on kidney discard, kidney allocation, and choice of peritransplant and posttransplant treatment are sometimes based on the histological information obtained from these biopsies. This comprehensive review evaluates the practical considerations of performing zero-time biopsies, the predictive performance of zero-time histology and composite histological scores, and the clinical utility of these biopsies. The predictive performance of individual histological lesions and of composite scores for posttransplant outcome is at best moderate. No single histological lesion or composite score is sufficiently robust to be included in algorithms for kidney discard. Dual kidney transplantation has been based on histological assessment of zero-time biopsies and improves outcome in individual patients, but the waitlist effects of this strategy remain obscure. Zero-time biopsies are valuable for clinical and translational research purposes, providing insight in risk factors for posttransplant events, and as baseline for comparison with posttransplant histology. The molecular phenotype of zero-time biopsies yields novel therapeutic targets for improvement of donor selection, peritransplant management and kidney preservation. It remains however highly unclear whether the molecular expression variation in zero-time biopsies could become a better predictor for posttransplant outcome than donor/recipient baseline demographic factors.

Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre-implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function

“…On the base of KDPI score combined with donors' actual situation in China, we consider donor age, cerebrovascular cause of death, history of hypertension, sCr before kidney procurement, hypotension and CPR incidence as a suitable donor evaluation system [15]. The pre-implantation biopsy is frequently performed and serves as another important tool for evaluating the kidney lesions, particularly in cases of ECD [5,23]. To better quantitate histopathologic features, the Remuzzi scoring system was adapted to assess chronic lesions of donation kidneys.…”

Preimplantation Kidney Biopsies of Extended Criteria Donors Have a Heavier Inflammatory Burden Than Kidneys From Standard Criteria Donors

“…Some transcriptomic studies analyses have provided mechanistic insights about the value of molecular markers over the histological findings. 22 …”

Chronic histological changes in deceased donor kidneys at implantation do not predict graft survival: a single‐centre retrospective analysis

“…A Karpinski (K) score was reported based on appearances within the glomerular, interstitial, tubular and vascular compartments; each component scoring between 0 (no chronic changes) and 3 (severe chronic changes), giving a total score between 0 and 12 [16]. The K score is essentially identical to the Remuzzi (or Pirani) score, differing only in minor definitions of vasculopathy and the number of glomeruli needed for adequacy [12,17]. Biopsies were considered inadequate if the sample contained <20 glomeruli, as previously described [16]; these kidneys were excluded from outcome analyses.…”

“…Patients were grouped based on K score (i.e. low K score (0-4) vs. high K score (5)(6)(7)(8)(9)(10)(11)(12)). This threshold reflects utilization scoring thresholds for single kidney transplants [18,19].…”

“…Preimplantation kidney biopsies are contentious, as the evidence-base for this approach is considered by some to be weak [11,12]. Their widespread use has been proposed as one of the underlying causes for the perceived high rate of kidney discard in the US [13,14].…”