Impact of the pre-transplant histological score on 3-year graft outcomes of kidneys from marginal donors: a single-centre study

Carta, Paolo; Zanazzi, M.; Caroti, Leonardo; Buti, Elisa; Mjeshtri, Anduela; Maria, L. Di; Raspollini, Maria Rosaria; Minetti, Enrico

doi:10.1093/ndt/gft292

Cited by 16 publications

(20 citation statements)

References 25 publications

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“…Our study confirms and expands previous evidence that histological criteria for allocation of marginal kidneys to single transplantation can be widened to include grafts with a score of 4 (31-33). Since those grafts represented almost 20% of the kidneys that underwent pre-transplant biopsy evaluation in our cohort, our results could have major implications in further expanding the pool of available donors.…”

Section: Discussionsupporting

confidence: 88%

The Kidney Donor Profile Index (KDPI) of Marginal Donors Allocated by Standardized Pretransplant Donor Biopsy Assessment: Distribution and Association With Graft Outcomes

Gandolfini

Buzio

Zanelli

et al. 2014

American Journal of Transplantation

110

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Pre-transplant donor biopsy (PTDB)-based marginal-donor allocation systems to single or dual renal transplantation could increase the use of organs with Kidney Donor Profile Index (KDPI) in the highest range (e.g. >80 or >90), whose discard rate approximates 50% in the US. To test this hypothesis, we retrospectively calculated the KDPI and analyzed the outcomes of 442 marginal kidney transplants (340 single transplants: 278 with a PTDB Remuzzi score <4 [median KDPI:87; interquartile range(IQR):78-94] and 62 with a score =4 [median KDPI:87; IQR:76-93]; 102 dual transplants [median KDPI: 93; IQR:86-96]) and 248 single standard transplant controls [median KDPI:36; IQR:18-51]. PTDB-based allocation of marginal grafts led to a limited discard rate of 15% for kidneys with KDPI of 80-90 and of 37% for kidneys with a KDPI of 91-100. Although 1-year eGFRs were significantly lower in recipients of marginal kidneys (-9.3, -17.9, and -18.8ml/min, for dual transplants, single kidneys with PTDB score <4, and =4, respectively; P<0.001), graft survival (median follow-up 3.3 years) was similar between marginal and standard kidney transplants (hazard ratio: 1.20 [95% confidence interval: 0.80 to 1.79; P=0.38]). In conclusion, PTDB-based allocation allows the safe transplantation of kidneys with KDPI in the highest range that may otherwise be discarded.

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Section: Discussionsupporting

confidence: 88%

The Kidney Donor Profile Index (KDPI) of Marginal Donors Allocated by Standardized Pretransplant Donor Biopsy Assessment: Distribution and Association With Graft Outcomes

Gandolfini

Buzio

Zanelli

et al. 2014

American Journal of Transplantation

110

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“…Despite a high allograft recovery rate reported in highest risk donors, kidneys with the highest KDPI score might have superior outcomes with a lower RS (<4) than those with a higher RS score (RS = 4) . In our analysis, our single‐center results of PTDB show a lower discard rate (19.8%) for the highest KDPI group and marginal kidneys with a RS of 4 allocated to single transplantation did not show lower graft or patient survival, previously described by other studies . Our study also shows that the use of a relatively low threshold (RS ≤ 4) appears to be safe for single kidney transplantation and identifies good organs from donors with several risk factors that would otherwise be rejected.…”

Section: Discussionsupporting

confidence: 60%

Histopathological evaluation of pretransplant donor biopsies in expanded criteria donors with high kidney donor profile index: a retrospective observational cohort study

et al. 2017

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There is no consensus on the allocation of renal transplants from expanded criteria donors (ECD). The Kidney Donor Profile Index (KDPI) is used without the need for pretransplant donor biopsies (PTDB). We explored whether PTDB based on Remuzzi Score (RS) allows identification of those marginal kidneys in the highest calculated KDPI risk group (>91%) that appropriate for single transplantation. A retrospective study was conducted of 485 consecutive kidneys procured from a single center and transplanted if the RS was ≤4. We compared 5-year kidney and patients survival between KDPI groups and between RS <4 or =4 in the highest KDPI group. The median KDPI (interquartile range) was 71 (66-76) for KDPI <80% (n = 77), 86 (81-90) for KDPI 81-90% (n = 82), and 97 (94-100) for KDPI >91% (n = 205). Patient survival at 5 years was 85.7%, 85.3%, and 76.09% (P = 0.058) and death-censored graft survival was 84.4%, 86.5%, 73.6% (P = 0.015), respectively for each KDPI group. In >91% calculated KDPI group, there were no differences in graft survival depending on the RS (<4 vs. =4) (P = 0.714). The implementation of PTDB based on RS used for allocation of organs with the highest KDPI range could support to the acceptance of suitable organs for single transplantation with good patient and graft survival rate.

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“…Four of eight studies reported an association with GF , while four others did not find an association with GF . Of three studies that 0 used morphometry to quantitate chronic injury, two reported an association with GF , while one did not .…”

Section: Resultsmentioning

confidence: 88%

“…Ortiz et al showed a correlation between CADI score and serum creatinine at 6 months and 2 years, but not at 1 year. However, four other studies found no association between histologic scores and graft function .…”

Section: Resultsmentioning

confidence: 90%

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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Impact of the pre-transplant histological score on 3-year graft outcomes of kidneys from marginal donors: a single-centre study

Cited by 16 publications

References 25 publications

The Kidney Donor Profile Index (KDPI) of Marginal Donors Allocated by Standardized Pretransplant Donor Biopsy Assessment: Distribution and Association With Graft Outcomes

The Kidney Donor Profile Index (KDPI) of Marginal Donors Allocated by Standardized Pretransplant Donor Biopsy Assessment: Distribution and Association With Graft Outcomes

Histopathological evaluation of pretransplant donor biopsies in expanded criteria donors with high kidney donor profile index: a retrospective observational cohort study

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

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