Evaluation of pre-implantation kidney biopsies: Comparison of Banff criteria to a morphometric approach

Lopes, José António; Moreso, Francesc; Riera, L.; Carrera, Marta; Ibernón, Meritxell; Fulladosa, Xavier; Grinyó, Josep M.; Serón, Daniel

doi:10.1111/j.1523-1755.2005.00241.x

Cited by 89 publications

(82 citation statements)

References 27 publications

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“…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.…”

Section: Discussioncontrasting

confidence: 45%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

mentioning

confidence: 99%

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

Tavares-da-Silva¹,

Oliveira²,

Castelo³

et al. 2014

Transplantation Proceedings

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Introduction. Renal transplantation is the best treatment for end-stage renal disease, including when using expanded criteria donors (ECD) kidneys. However, these suboptimal kidneys should be evaluated rigorously to meet their usefulness. Opinions differ about the best way to evaluate them. Materials and Methods. We retrospectively reviewed kidneys from ECD harvested by a single academic institution between January 2008 and September 2013. Needle biopsies were performed at the time of the harvest when considered relevant by the transplant team. Two pathologists where responsible for their analysis; the Remuzzi classification has been used in all cases. Results. We evaluated 560 ECD kidneys. Biopsies were made in 197 (35.2%) organs, 20 of which were considered not usable and 36 good only for double transplantation. Sixty-three kidneys (11.3%) were discarded by the transplant team based on the biopsy result and clinical criteria. Donors who underwent a biopsy were older (P < .001) and had a worse glomerular filtration rate (GFR; P ¼ .001). Comparing donors approved and rejected by the biopsy, the rejected donors were heavier (P ¼ .003) and had a lower GFR (P ¼ .002). Cold ischemia time was longer for the biopsy group (P < .001). Regarding graft function, the biopsy overall score correlated with the transplant outcome in the short and long term. Separately, glomeruli and interstitium scores were correlated with recipient's GFR in the earlier periods (3 months; P ¼ .025 and .037), and the arteries and tubules correlated with GFR in the longer term (at 3 years P ¼ .004 and .010). Conclusion. The decision on the usability of ECD grafts is complex. At our center, we chose a mixed approach based on donor risk. Low-risk ECD do not require biopsy. In more complex situations, especially older donors or those with a lower GFR, prompted a pretransplant biopsy. The biopsy results proved to be useful as they relate to subsequent transplant outcomes, thereby allowing us to exclude grafts whose function would most probably be less than optimal.

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Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Tavares-da-Silva¹,

Oliveira²,

Castelo³

et al. 2014

Transplantation Proceedings

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“…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). Nevertheless, these studies have generally failed to show strong correlations between histologic findings of implantation biopsies and kidney graft survival.…”

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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“…He reported that donor structural and functional parameters are independent. [10] Several other studies [11][12][13][14] have investigated the correlation between morphologic data, serum parameters, and graft function. However, none of them used ultrastructure as a parameter in their comparisons.…”

Section: Discussionmentioning

confidence: 99%

Correlation between Proteinuria Level and Renal Morphology with Special Reference to Electron Microscopy in Kidney Donors

et al. 2008

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Evaluation of pre-implantation kidney biopsies: Comparison of Banff criteria to a morphometric approach

Abstract: Combined evaluation of donor glomerulosclerosis, chronic vascular and interstitial damage according to Banff criteria allows a precise prediction of graft outcome. Morphometric evaluation of donor biopsies does not improve the predictive value of semiquantitative grading.

Cited by 89 publications

References 27 publications

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

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

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

Correlation between Proteinuria Level and Renal Morphology with Special Reference to Electron Microscopy in Kidney Donors

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