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

Abstract

Summary The use of preimplantation kidney biopsies (PIKBs) to aid deceased donor kidney utilization decisions is controversial. Outcomes of transplants that had been biopsied after the decision had been made to implant were analysed, in order to determine the association between chronic histological changes at implantation and graft outcomes. A retrospective analysis of transplants between the year range 2006–2015 was performed. Karpinski scores on biopsies were collected, and graft outcomes were analysed using univariate and multivariable techniques. Also, Karpinski scores from single and dual kidney transplants from older donors were examined to determine if knowledge of the score preoperatively would have altered utilization. Four hundred and eight single kidneys were transplanted. Although kidneys with scores >4 had lower 1‐ and 3‐year median (IQR) estimated glomerular filtration rates (eGFRs) than those scoring 0–4 (51 (37–66) vs. 35 (26–52) ml/min/1.73 m2, P < 0.001, and 52 (34–64) vs. 35 (24–52) ml/min/1.73 m2, P < 0.001, respectively), there was no significant association between Karpinski score and death‐censored graft survival on univariate or multivariable analyses. The utilization analysis (75 single and 25 dual kidney transplant recipients) suggested that systematic use of PIKBs would have resulted in 29% fewer patients being transplanted. This analysis does not support the systematic use of PIKBs to determine deceased donor kidney utilization.

An international comparison of deceased donor kidney utilization: What can the United States and the United Kingdom learn from each other?

“…URs of older donors could theoretically be improved by the use of preimplant kidney biopsies, whose practice and utility vary greatly internationally and nationally . However, in the US biopsies are often cited as the primary reason for kidney discard .…”

Evaluation of donor kidneys prior to transplantation: an update of current and emerging methods

“…Many of the studies on this topic are of modest quality and are generally characterized by a high heterogenicity in endpoints studied, technical aspects and histological scores used . While some studies showed a correlation between composite histological scores and graft survival , others did not . In the largest study to date, a registry analysis by Sung et al .…”

Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom

“…The use of preimplantation kidney biopsies to identify and quantify chronic histologic changes was not widespread in the United Kingdom during the study period (11). The evidence base underpinning this approach remains contested (8,(11)(12)(13)(41)(42)(43). A current United Kingdom trial aims to determine if national availability of preimplantation kidney biopsies can increase the utilization of organs from older donors (44).…”

“…Deciding which kidneys from older donors should be implanted as two single transplants, as a dual transplant, or which should be discarded is challenging. Although some centers in the United Kingdom and internationally use preimplantation histologic evaluation to help identify which kidneys should be implanted as duals (2,8,9), no clinical or histologic parameters have been widely accepted to aid utilization decisions (10)(11)(12)(13)(14)(15)(16). There is also little clinical guidance regarding recipient selection, and many offering policies for kidneys from older donors are based on donor criteria alone (17,18).…”