Donor Structural and Functional Parameters Are Independent Predictors of Renal Function at 3 Months

Ibernón, Meritxell; González-Segura, C.; Moreso, Francesc; Gomà, Montse; Serón, Daniel; Fulladosa, Xavier; Torras, Juan; García-Huete, Lucía; Gil-Vernet, S.; Cruzado, Josep M.; Carrera, Marta; Duarte, Valeria E.; Grinyó, J.M.

doi:10.1016/j.transproceed.2007.06.026

Cited by 10 publications

(12 citation statements)

References 11 publications

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“…A number of studies have examined the relationship between donor histologic scores and kidney function at different times after transplantation with mixed results. Two studies reported an association between histologic scores and eGFR at 3 months . Three studies were able to find an association with eGFR at 1 year posttransplant .…”

Section: Resultsmentioning

confidence: 98%

The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review

Wang

Wetmore

Crary

et al. 2015

American Journal of Transplantation

132

175

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Despite a growing organ shortage in the United States, many deceased donor kidneys removed for transplantation are discarded. Kidney biopsy findings often play a role in these discards, although it is not clear whether biopsies reliably inform acceptance decisions. Therefore, we carried out a systematic review of the medical literature on the utility of both procurement and implantation biopsies for predicting posttransplant outcomes. Between January 1, 1994 and July 1, 2014, 47 studies were published in the English language literature that examined the association between pretransplant donor biopsy findings from 50 or more donors (with more than half being from deceased donors) and either posttransplant graft failure, delayed graft function, or graft function. In general, study quality was poor. All were retrospective or did not indicate if they were prospective. Results were heterogeneous, with authors as often as not concluding that biopsy results did not predict posttransplant outcomes. The percent glomerular sclerosis was most often examined, and failed to predict graft failure in 7 of 14 studies. Of 15 semiquantitative scoring systems proposed, none consistently predicted posttransplant outcomes across studies. Routine use of biopsies to help determine whether or not to transplant a kidney should be reexamined.

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Section: Resultsmentioning

confidence: 98%

The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review

Wang

Wetmore

Crary

et al. 2015

American Journal of Transplantation

132

175

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show abstract

“…These biopsies have usually been paraffin embedded, carefully stained, and interpreted by renal pathologists. Different scoring systems have been used to assess the amount of chronic damage (11,15,23,27,29,32,33,39,40). Morphometry has also been used to determine the amount of chronic damage in the transplanted kidney as accurately as possible (23,25,32).…”

Section: Discussionmentioning

confidence: 99%

The Role of Procurement Biopsies in Acceptance Decisions for Kidneys Retrieved for Transplant

Kasiske

Stewart

Bista³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives There is a shortage of kidneys for transplant, and many patients on the deceased donor kidney transplant waiting list would likely benefit from kidneys that are currently being discarded. In the United States, the most common reason given for discarding kidneys retrieved for transplant is procurement biopsy results. This study aimed to compare biopsy results from discarded kidneys with discard attributed to biopsy findings, with biopsy results from comparable kidneys that were successfully transplanted.Design, setting, participants, & measurements In this retrospective, observational, case-control study, biopsy reports were examined from 83 kidneys discarded in 2010 due to biopsy findings (cases), 83 contralateral transplanted kidneys from the same donor (contralateral controls), and 83 deceased donors randomly matched to cases by donor risk profile (randomly matched controls). A second procurement biopsy was obtained in 64 of 332 kidneys (19.3%).Results The quality of biopsy reports was low, with amounts of tubular atrophy, interstitial inflammation, arteriolar hyalinosis, and acute tubular necrosis often not indicated; 69% were wedge biopsies and 94% used frozen tissue. The correlation between first and second procurement biopsies was poor; only 25% of the variability (R 2 ) in glomerulosclerosis was explained by biopsies being from the same kidney. The percentages of glomerulosclerosis overlapped substantially between cases, contralateral controls, and randomly matched controls: 17.1%615.3%, 9.0%66.6%, and 5.0%65.9%, respectively. Of all biopsy findings, only glomerulosclerosis.20% was independently correlated with discard (cases versus contralateral controls; odds ratio, 15.09; 95% confidence interval, 2.47 to 92.41; P=0.003), suggesting that only this biopsy result was used in acceptance decisions. One-year graft survival was 79.5% and 90.7% in contralateral and randomly matched controls, respectively, versus 91.6% among all deceased donor transplants in the Scientific Registry of Transplant Recipients.Conclusions Routine use of biopsies could lead to unnecessary kidney discards.

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“…Others have focused on specific pathologic lesions on biopsy performed at retrieval of kidneys from an older donor, to determine how best to use the DD kidney (11). Single-center data experience evaluating implantation biopsies (IBx) suggests that glomerular (12)(13)(14)(15)(16)(17), tubulointerstitial (18 -22), vascular pathologic condition (15,19,(21)(22)(23)(24)(25)(26), or composite biopsy scores (27,28) may be predictive of clinical outcomes. There are a number of limitations to these studies, including a selection bias to which donor kidneys were biopsied, small study size, varying biopsy technique (wedge or core), lack of comprehensive assessment of all histologic features, and relatively short follow-up.…”

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confidence: 99%

The Prognostic Utility of Deceased Donor Implantation Biopsy in Determining Function and Graft Survival After Kidney Transplantation

et al. 2010

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Donor Structural and Functional Parameters Are Independent Predictors of Renal Function at 3 Months

Cited by 10 publications

References 11 publications

The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review

The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review

The Role of Procurement Biopsies in Acceptance Decisions for Kidneys Retrieved for Transplant

The Prognostic Utility of Deceased Donor Implantation Biopsy in Determining Function and Graft Survival After Kidney Transplantation

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