Impact of pre‐transplant biopsy on 5‐year outcomes of expanded criteria donor kidney transplantation

Abstract

Aim: Compared to Standard Criteria Donors (SCD), Expanded Criteria Donor (ECD) kidneys are associated with poorer outcomes, although pre-transplant biopsy may mitigate risks. This study assessed 5-year outcomes of deceased-donor kidney transplant recipients, comparing recipients of ECD allografts evaluated histologically to recipients of SCD and ECD kidneys assessed clinically. Methods: This is a single-centre retrospective study. From November 2005 to December 2009 (Era 1), donors were assessed clinically for suitability for kidney donation. From December 2009 to October 2017 (Era 2), kidneys from ECDs and diabetics underwent pre-transplant biopsy and were allocated based on Remuzzi score. Outcomes of Era 1 and 2 recipients were compared. Results: ECD kidney transplantation increased from 30.4% to 40.0% from Era 1 to 2. Univariable Cox regression, stratified by transplant era, found that 5-year graft loss was highest with Era 1 ECD (HR 2.5, 95% CI 1.1-5.5, P = .027) while graft loss for Era 2 ECD recipients was similar to SCD recipients. There was no difference in 5-year recipient survival. Amongst Era 1 ECD recipients, 51.2% experienced rejection compared to 30.8-41.5% for other subgroups. Five-year eGFR was higher with Era 2 ECD at 48.4 (33.3-60.7) ml/min/1.73 m 2 compared to 42.2 (35.8-57.3) ml/min/1.73 m 2 for Era 1 ECD. However, these differences were not statistically significant. Conclusion: Introduction of pre-transplant biopsy assessment may be associated with improved outcomes of ECD kidney recipients such that they are now comparable to SCD kidney recipients, with benefits persisting over 5 years.

Outcomes of kidneys used for transplantation: an analysis of survival and function

“…The reports are both suggestive that machine-learning algorithms (artificial intelligence) applied to pre-transplant data may predict the likelihood of gaining eGFR-1, possibly similar to that observed after LDKT. There is additional data beyond KDPI variables available within the OPTN database, including renal volume/mass ( 30 , 31 ), donor biopsy ( 32 , 33 ), (hypo)perfusion parameters ( 34 ), pump ( 35 ), and ischemia characteristics ( 36 ), that may improve the predictive capacity for post-transplant renal function.…”

A Review of Current and Emerging Trends in Donor Graft-Quality Assessment Techniques

“…Ultimately, the most crucial factor is how the histopathological results correlate with long-term graft survival. Many studies have attempted to address the predictive value of renal biopsy with respect to graft outcomes, but the results of these studies have been predominantly inconclusive [20][21][22][23]. For instance, Traynor et al, conducted a retrospective study that examined kidney transplants over a 10-year period to determine whether pretransplant histology is able to predict graft outcomes at 5 years, and whether donor histology adds incremental data to the current clinical parameters.…”

“…While the results of these reports suggest that that histological assessment adds little additional prognostic information aside from clinical parameters [20], Yap et al, found that the histological evaluation of ECD kidneys was associated with improved long-term graft survival. Their results suggest that pretransplant biopsy assessment can enable ECD kidneys to be used as a safe and viable option during persistent shortages of kidney donors [21]. The divergence between recent studies highlights the need for a prospective controlled trial to evaluate the predictive value of pretransplant biopsies.…”

Advantages of Using a Web-based Digital Platform for Kidney Preimplantation Biopsies

“…[ 4 ] Despite no agreement has been reached on the “best” grading system for preimplantation biopsies,[ 5 6 7 8 ] from that publication, the Remuzzi–Karpinski score has been widely adopted. [ 9 10 ] Although preimplantation biopsy may generate data for accepting or rejecting an organ, it represents a controversial issue. The major issue that undermines the reliability of histopathology is the low rate of agreement between pathologists on the Remuzzi–Karpinski score.…”