Correlation of histologic findings on preimplant biopsy with kidney graft survival

Abstract

Summary Kidney biopsies are being used to evaluate marginal deceased donor organs, but, the literature on the utility of this practice remains conflicting. We re‐examined this issue by performing a multivariate analysis of 597 kidney transplant recipients. The presence of moderate arteriosclerosis and/or moderate arteriolosclerosis (MA), defined as ≥25% luminal compromise, was a significant predictor of graft outcome in standard criteria donors (multivariate, P = 0.01) and in expanded criteria donors (ECD) as defined by UNOS criteria (univariate P = 0.02). One‐, 3‐, and 5‐year overall allograft survival with MA was 71%, 58%, and 40%, respectively. Increasing degrees of glomerulosclerosis (GS) were associated with earlier graft failure on univariate (P = 0.03) but not multivariate analysis (P = 0.36). GS > 20% and interstitial fibrosis >25% had a low frequency in the material reviewed, likely reflecting our organ utilization practices, and did not have a demonstrable effect on graft outcome. Clinical parameters independently associated with worse graft function were ECD status (P < 0.05), retransplantation (P = 0.004), recipient age (P < 0.05), and delayed graft function (P < 0.0001). Donor vascular disease is an independent risk factor for suboptimal graft survival. Great caution should be exercised in the decision to transplant kidneys with moderate arterial and/or arteriolar luminal narrowing.

Pretransplant Biopsy in Expanded Criteria Donors: Do We Really Need It?

“…The same happens with the other histologic compartments. Although some authors do not find any relationship of tubules, interstitium, and arteries with graft function [7,10,29], others do [8,11,28,31]. In our series, the overall biopsy score correlated with transplant outcome at all time points.…”

“…Some groups found no relation between the percentage of glomerulosclerosis and renal function [31], although the majority consider it a very important parameter and discard kidneys with glomerulosclerosis of >20% [11,28] or even at lower values [7,8]. The same happens with the other histologic compartments.…”

“…Some groups decide allocation based on peer age [4]; others use perfusion machines parameters [5], others prefer donor scores based on clinical data, and still others use histologic criteria. Even among histologic evaluation supporters there are some differences, namely, classification used [6e9], relative importance of a histologic parameter over another [7,8,10,11], sampling technique [12e15], or sample processing [16,17].…”

Microangiopathy is Common in Submucosal Vessels of the Colon in Patients With Diabetes Mellitus

“…In each case, at minimum three arterioles with a circular cross-section were selected, and their outer and inner circumferences were traced manually, followed by calculation of parameters including wall thickness and wall-to-lumen ratio [12]. A wall-to-lumen ratio ≥ 25% is classified as microangiopathy (arteriolosclerosis) [13]. We classified the changes as mild, moderate, and severe when the degree of luminal compromise was 25-30%, 31-50%, and >50%, respectively.…”

Procurement Biopsies in Kidneys Retrieved for Transplantation

“…Interpretation of a donor kidney biopsy, however, requires a meticulous evaluation of the degree of glomerulosclerosis, vessel arteriosclerosis, vessel hyalinosis, and interstitial fibrosis. Previous studies (3)(4)(5)(6)(7)(8)(9) have demonstrated considerable variability in biopsy findings based on the type of biopsy (wedge versus needle), sample size, experience of the pathologist, and inconsistency in reporting biopsy findings. Almost all the biopsies were evaluated by frozen section because they need to be read as soon as possible.…”