A kidney discard decision strategy based on zero‐time histology analysis could lead to an unjustified increase in the organ turndown rate among ECD

Abstract

Summary The utility of zero‐time kidney biopsies (KB) in deciding to accept expanded criteria donor (ECD) kidneys remains controversial. However, zero‐time histology is one of the main causes for discarding kidneys in the United States. In a single‐centre study, we examined the utility and impact on outcome of the use of frozen section zero‐time KB among ECD. Ninety‐two zero‐time KB were analysed for accept/discard decision between 2005 and 2015 among ECD. 53% of kidneys were rejected after zero‐time KB analysis; there was no difference in individual clinical and biological data between accepted/rejected groups. However, histology of rejected kidneys showed more sclerotic glomeruli (20% vs. 8%; P < 0.001), increased interstitial fibrosis (1.25 ± 0.12 vs. 0.47 ± 0.09; P < 0.0001), more arteriosclerosis (2.14 ± 0.17 vs. 1.71 ± 0.11; P = 0.0032) and arteriolar hyalinosis (2.15 ± 0.12 vs. 1.55 ± 0.11; P = 0.0006). Using propensity score matching, we generated a group of 42 kidney allograft recipients who received a transplant matched for donor zero‐time histology and clinical characteristics with donors whose kidneys were rejected. Interestingly, their 1‐ and 5‐year graft survival and function were similar to the global cohort of ECD recipients. In conclusion, when performed, zero‐time KB was a decisive element for kidney discard decision. However, adverse zero‐time histology was not associated with poorer graft survival and kidney function among ECD.

Preoperative Risk Assessment of Early Kidney Graft Loss

“…Still, their clinical usefulness in guiding organ acceptance is questionable because their predictive power for graft outcome is weak. 10,[14][15][16][17] As an explanation, complications such as graft thrombosis, hemorrhage, and acute rejection cause most of the EGLs, and their risk is difficult to evaluate. In terms of prediction modeling for graft survival, the best c-statistics are 0.82-0.85 of the iBox-score, which considers only posttransplantation variables.…”

The Independent Effects of Procurement Biopsy Findings on 10-Year Outcomes of Extended Criteria Donor Kidney Transplants

“…Whether biopsy findings have a clinically meaningful, independent association with transplant recipient outcomes beyond more easily obtained clinical parameters remains elusive, as the literature is filled with conflicting findings. 3 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 Conclusions are often drawn from small, single-center studies. Statistical interpretation is often over-reliant on arbitrary P value thresholds, instead of a more nuanced approach mindful of type II errors.…”