Renal transplants from older deceased donors: Is pre-implantation biopsy useful? A monocentric observational clinical study

Colussi, Giacomo; Casati, Costanza; Colombo, Valeriana; Camozzi, Mario; Salerno, Fabio

doi:10.5500/wjt.v8.i4.110

Cited by 5 publications

(3 citation statements)

References 35 publications

(63 reference statements)

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“…The usefulness of preimplantation biopsy as a predictive tool for graft survival has not been validated yet and some studies discuss its value for the assessment of the quality of organs from ECD [ 15 , 18 - 20 ]. In our case, all the grafts had a preimplantation biopsy and only those with a global score <7 were accepted.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Expanded Criteria Donors Using the Kidney Donor Profile Index and the Preimplantation Renal Biopsy

Villanego¹,

Vigara²,

Cazorla³

et al. 2022

Transpl Int

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The increasing comorbidity of kidney transplant (KT) donors make it necessary to develop scores to correctly assess the quality of kidney grafts. This study analyzes the usefulness of the preimplantation biopsy and the Kidney Donor Profile Index (KDPI) as indicators of KT survival from expanded criteria donors (ECD). Retrospective study of KT in our center between January 2010 to June 2019 who received a kidney from an ECD and underwent a preimplantation biopsy. 266 KT were included. Graft survival was categorized by KDPI quartiles: Q1 = 86%, Q2 = 95%, Q3 = 99% and Q4 = 100%. KT from KDPI Q1 presented better survival (p = 0.003) and Q4 donors had worse renal function (p = 0.018) and poorer glomerular filtration rate (3rd month; p = 0.017, 1st year; p = 0.010). KT survival was analyzed according to KDPI quartile and preimplantation biopsy score simultaneously: Q1 donors with biopsy score ≤3 had the best survival, especially comparing against Q3 with a biopsy score >3 and Q4 donors (p = 0.014). In multivariable analysis, hyaline arteriopathy, glomerulosclerosis, and KDPI Q4 were predictors for graft survival. High KDPI and a greater histological injury in the preimplantation biopsy, especially glomerular and vascular lesions, were related to a higher rate of KT loss from ECD.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Expanded Criteria Donors Using the Kidney Donor Profile Index and the Preimplantation Renal Biopsy

Villanego¹,

Vigara²,

Cazorla³

et al. 2022

Transpl Int

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“…Two recent Italian studies on the utility of pre-implantation biopsy in allocating ECD kidneys[4,55] concluded that histological evaluation was not superior to donor clinical evaluation in allocating ECD kidneys either as a single kidney or as a dual kidney transplant. The authors concluded that, according to their experience, the histological score poorly evaluates the donor kidney quality.…”

Section: Histological Evaluation Of Donor Kidneysmentioning

confidence: 99%

Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best?

Salvadori¹,

Tsalouchos²

2019

WJT

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Organ shortage represents one of the major limitations to the development of kidney transplantation. To increase the donor pool and to answer the ever increasing kidney request, physicians are recurring to marginal kidneys as kidneys from older donors, from hypertensive or diabetic donors and from non-heart beating donors. These kidneys are known to have frequently a worse outcome in the recipients. To date major problem is to evaluate such kidneys in order to use or to discard them before transplantation. The use of such kidneys create other relevant question as whether to use them as single or dual transplant and to allocate them fairly according transplant programs. The pre-transplant histological evaluation, the clinical evaluation of the donor or both the criteria joined has been used and according the time each criterion prevailed over the others. Aim of this review has been to examine the advantages and the drawbacks of any criterion and how they have changed with time. To date any criterion has several limitations and several authors have argued for the development of new guidelines in the field of the kidney evaluation for transplantation. Several authors argue that the use of omic technologies should improve the organ evaluation and studies are ongoing to evaluate these technologies either in the donor urine or in the biopsies taken before transplantation.

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“…Histopathological evaluation of the donor kidney via biopsy is an important component of the comprehensive evaluation, especially for ECD evaluation [4,5]. The pre-implantation biopsy is performed not only to evaluate the potential chronic changes in renal structure, but also to assess ischemic injury in the donated kidney [11]. Hypothermic mechanical perfusion (HMP) has been shown to mitigate DGF by removing residual renal microthrombi, dredging renal micro vessels and provide measures to assess renal function [6,7,12].…”

Section: Introductionmentioning

confidence: 99%

Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre-implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function

Zheng

Ding

et al. 2020

Renal Failure

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2020) Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre-implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function, Renal Failure, 42:1, 369-376, ABSTRACTBackground: Due to the current high demand for transplant tissue, an increasing proportion of kidney donors are considered extended criteria donors, which results in a higher incidence of delayed graft function (DGF) in organ recipients. Therefore, it is important to fully investigate the risk factors of DGF, and establish a prediction system to assess donor kidney quality before transplantation. Methods: A total of 333 donation after cardiac death kidney transplant recipients were included in this retrospective study. Both univariate and multivariate analyses were used to analyze the risk factors of DGF occurrence. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of variables on DGF posttransplant. Results: The donor clinical scores, kidney histopathologic Remuzzi scores and hypothermic mechanical perfusion (HMP) parameters (flow and resistance index) were all correlated. 46 recipients developed DGF postoperatively, with an incidence of 13.8% (46/333). Multivariate logistic regression analysis of the kidney transplants revealed that the independent risk factors of DGF occurrence post-transplantation included donor score (OR ¼ 1.12, 95% CI 1.06-1.19, p < 0.001), Remuzzi score (OR ¼ 1.21, 95% CI 1.02-1.43, p ¼ 0.029) and acute tubular injury (ATI) score (OR ¼ 4.72, 95% CI 2.32-9.60, p < 0.001). Prediction of DGF with ROC curve showed that the area under the curve was increased to 0.89 when all variables (donor score, Remuzzi score, ATI score and HMP resistance index) were considered together. Conclusions: Combination of donor clinical information, kidney pre-implant histopathology and HMP parameters provide a more accurate prediction of DGF occurrence post-transplantation than any of the measures alone.

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Renal transplants from older deceased donors: Is pre-implantation biopsy useful? A monocentric observational clinical study

Cited by 5 publications

References 35 publications

Evaluation of Expanded Criteria Donors Using the Kidney Donor Profile Index and the Preimplantation Renal Biopsy

Evaluation of Expanded Criteria Donors Using the Kidney Donor Profile Index and the Preimplantation Renal Biopsy

Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best?

Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre-implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function

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