Deceased Donor Procurement Biopsy Practices, Interpretation, and Histology-Based Decision-Making: A Survey of US Kidney Transplant Centers

Lentine, Krista L.; Fleetwood, Vidya A.; Çalışkan, Yaşar; Randall, Henry B.; Wellen, Jason R.; Lichtenberger, Melissa; Dedert, Craig; Rothweiler, Richard; Marklin, Gary; Brockmeier, Diane; Husain, S. Ali; Mohan, Sumit; Kasiske, Bertram L.; Cooper, Matthew; Mannon, Roslyn B.; Axelrod, David A.

doi:10.1016/j.ekir.2022.03.021

Cited by 7 publications

(5 citation statements)

References 39 publications

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“…All responses (including multiple responses from a single center) were also presented as a secondary analysis, for comparison with the primary results, per previous methods (Tables S1-S5, SDC, http://links.lww.com/TP/C996). 9 Responses to each survey question were described with percentages and frequencies. To obtain percentages, we divided the number of responding program for an item by the total number of programs selected a given response option for the question, such that percentages reflect the proportions of item respondents, as per previously described methods.…”

Section: Discussionmentioning

confidence: 99%

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Indications, Techniques, and Barriers for Pancreas Transplant Biopsy: A Consensus Perspective From a Survey of US Centers

Singh,

Lentine,

Fleetwood

et al. 2024

Transplantation

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Background. Pancreas transplant biopsy practices for the diagnosis of rejection or other pathologies are not well described. Methods. We conducted a survey of staff at US pancreas transplant programs (March 22, 2022, to August 22, 2022) to assess current program practices and perceptions about the utility and challenges in the performance and interpretation of pancreas allograft biopsies. Results. Respondents represented 65% (76/117) of active adult pancreas transplant programs, capturing 66% of recent pancreas transplant volume in the United States. Participants were most often nephrologists (52%), followed by surgeons (46%), and other staff (4%). Pancreas allograft biopsies were performed mostly by interventional radiologists (74%), followed by surgeons (11%), nephrologists (8%), and gastroenterologists (1%). Limitations in the radiologist’s or biopsy performer’s comfort level or expertise to safely perform a biopsy, or to obtain sufficient/adequate samples were the two most common challenges with pancreas transplant biopsies. Pancreas transplant biopsies were read by local pathologists at a majority (86%) of centers. Challenges reported with pancreas biopsy interpretation included poor reliability, lack of reporting of C4d staining, lack of reporting of rejection grading, and inconclusive interpretation of the biopsy. Staff at a third of responding programs (34%) stated that they rarely or never perform pancreas allograft biopsies and treat presumed rejection empirically. Conclusions. This national survey identified significant variation in clinical practices related to pancreas allograft biopsies and potential barriers to pancreas transplant utilization across the United States. Consideration of strategies to improve program experience with percutaneous pancreas biopsy and to support optimal management of pancreas allograft rejection informed by histology is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Indications, Techniques, and Barriers for Pancreas Transplant Biopsy: A Consensus Perspective From a Survey of US Centers

Singh,

Lentine,

Fleetwood

et al. 2024

Transplantation

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Section: Methodsmentioning

confidence: 99%

“…Procurement kidney biopsies are used to assess a deceased organ donor's kidney for organ damage and potential kidney function ( 30 ). Over the years, kidney biopsies have become more widely used, but their usage varies greatly across the country ( 30 ). Recently, Organ Procurement and Transplantation Network policy proposed minimum adult kidney donor criteria which require biopsy such us: urine output of less than 100 ml in 24 h; donor has received hemodialysis or other renal replacement therapy either during most recent hospital admission or in the course of donor management; history of diabetes, including a hemoglobin A1c of 6.5 or greater during donor evaluation and management; KDPI greater than 85%; donor age 60 years old or greater; donor age 50–59, and meets at least two of the following criteria: history of hypertension; manner of death: cerebrovascular accident; terminal creatinine of 1.5 mg/dl or greater ( 31 ).…”

Section: Methodsmentioning

confidence: 99%

Development of a checklist framework for kidney transplantation

Nicolau-Raducu,

Ciancio,

Raveh

2024

Front. Transplant.

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BackgroundKidney transplantation is the therapy of choice for end-stage kidney disease, and a fast-growing transplant procedure worldwide. Diverse clinical practices for recipients and donors' selection and management between transplant centers hinder the creation and dissemination of an anesthesia-surgical checklist.MethodsComponents of the anesthesia-surgical checklist were selected after a review of the English literature using PubMed search for donor, recipient and graft protocols and outcomes of existing practices in the field of kidney transplantation. Key elements of the most relevant articles were combined with our own center's experience and formulated into the proposed checklist. The checklist is intended to be used perioperatively, once patient receives an offer.ResultsThe perioperative checklist centers primarily on the following donor and recipient's factors: (i) Review of the pretransplant candidate workup; (ii) Assessment of donor/graft status; (iii) Hypothermic machine perfusion parameters; (iv) Operating room management; (v) Sign out. The proposed kidney transplant checklist was designed to ensure consistency and completeness of diverse tasks and facilitates team communication and coordination.ConclusionWe present a novel standardized combined anesthesia-surgical checklist framework for kidney transplant aimed at increasing perioperative safety and streamline the perioperative care of recipients. Future validation studies will determine its clinical feasibility and post-implementation efficacy.

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“…Considering the marginal nature of these organs, preimplantation kidney biopsies have been used to provide a window on the state of the renal graft and it is considered in some settings a valuable decision-making tool as it helps to identify chronic or acute organ damage in order to estimate renal function after transplantation [4][5][6]. However, in spite of the well-reported clinical utility of this procedure, its use in the daily clinical practice is still debated and poorly standardized.…”

Section: Introductionmentioning

confidence: 99%

European Society for Organ Transplantation (ESOT)-TLJ 3.0 Consensus on Histopathological Analysis of Pre-Implantation Donor Kidney Biopsy: Redefining the Role in the Process of Graft Assessment

Zaza¹,

Cucchiari

Becker

et al. 2023

Transpl Int

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The ESOT TLJ 3.0. consensus conference brought together leading experts in transplantation to develop evidence-based guidance on the standardization and clinical utility of pre-implantation kidney biopsy in the assessment of grafts from Expanded Criteria Donors (ECD). Seven themes were selected and underwent in-depth analysis after formulation of PICO (patient/population, intervention, comparison, outcomes) questions. After literature search, the statements for each key question were produced, rated according the GRADE approach [Quality of evidence: High (A), Moderate (B), Low (C); Strength of Recommendation: Strong (1), Weak (2)]. The statements were subsequently presented in-person at the Prague kick-off meeting, discussed and voted. After two rounds of discussion and voting, all 7 statements reached an overall agreement of 100% on the following issues: needle core/wedge/punch technique representatively [B,1], frozen/paraffin embedded section reliability [B,2], experienced/non-experienced on-call renal pathologist reproducibility/accuracy of the histological report [A,1], glomerulosclerosis/other parameters reproducibility [C,2], digital pathology/light microscopy in the measurement of histological variables [A,1], special stainings/Haematoxylin and Eosin alone comparison [A,1], glomerulosclerosis reliability versus other histological parameters to predict the graft survival, graft function, primary non-function [B,1]. This methodology has allowed to reach a full consensus among European experts on important technical topics regarding pre-implantation biopsy in the ECD graft assessment.

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Deceased Donor Procurement Biopsy Practices, Interpretation, and Histology-Based Decision-Making: A Survey of US Kidney Transplant Centers

Cited by 7 publications

References 39 publications

Indications, Techniques, and Barriers for Pancreas Transplant Biopsy: A Consensus Perspective From a Survey of US Centers

Indications, Techniques, and Barriers for Pancreas Transplant Biopsy: A Consensus Perspective From a Survey of US Centers

Development of a checklist framework for kidney transplantation

European Society for Organ Transplantation (ESOT)-TLJ 3.0 Consensus on Histopathological Analysis of Pre-Implantation Donor Kidney Biopsy: Redefining the Role in the Process of Graft Assessment

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