Reproducibility of Deceased Donor Kidney Procurement Biopsies

Abstract

Background and objectivesUnfavorable histology on procurement biopsies is the most common reason for deceased donor kidney discard. We sought to assess the reproducibility of procurement biopsy findings.Design, setting, participants, & measurementsWe compiled a continuous cohort of deceased donor kidneys transplanted at our institution from 1/1/2006 to 12/31/2016 that had at least one procurement biopsy performed, and excluded cases with missing biopsy reports and those used in multiorgan transplants. Suboptimal histology was defined as the presence of advanced sclerosis in greater than or equal to one biopsy compartment (glomeruli, tubules/interstitium, vessels). We calculated κ coefficients to assess agreement in optimal versus suboptimal classification between sequential biopsy reports for kidneys that underwent multiple procurement biopsies and used time-to-event analysis to evaluate the association between first versus second biopsies and patient and allograft survival.ResultsOf the 1011 kidneys included in our cohort, 606 (60%) had multiple procurement biopsies; 98% had first biopsy performed at another organ procurement organization and their second biopsy performed locally. Categorical agreement was highest for vascular disease (κ=0.17) followed by interstitial fibrosis and tubular atrophy (κ=0.12) and glomerulosclerosis (κ=0.12). Overall histologic agreement (optimal versus suboptimal) was κ=0.15. First biopsy histology had no association with allograft survival in unadjusted or adjusted analyses. However, second biopsy optimal histology was associated with a higher probability of death-censored allograft survival, even after adjusting for donor and recipient factors (adjusted hazard ratio, 0.50; 95% confidence interval, 0.34 to 0.75; P=0.001).ConclusionsDeceased donor kidneys that underwent multiple procurement biopsies often displayed substantial differences in histologic categorization in sequential biopsies, and there was no association between first biopsy findings and post-transplant outcomes.

Impact of Deceased Donor Kidney Procurement Biopsy Technique on Histologic Accuracy

“…For each of these histologic parameters, we used the previously validated scoring system that assigns a score of 0 (most favorable) to 3 (least favorable) consistent with thresholds from prior studies using this cohort (Table 1). 10 In cases in which a range of values was reported for any compartment, the lower end of the range was used to assign the histologic score (e.g. "moderate to severe" vascular disease was scored as 2).…”

“…However, several previous studies have demonstrated that-unlike high-quality reperfusion biopsies-procurement biopsies are typically poorly reproducible, not reflective of the gold-standard histology to which clinicians are accustomed, and, as a result, poorly predictive of posttransplantation outcomes. 11À17 However, although procurement biopsy findings overall are not associated with allograft outcomes, we recently showed that procurement biopsies performed by a specific organ procurement organization are associated with posttransplantation outcomes, 10 leading to our hypothesis that certain practice pattern variations, such as tissue sampling technique and the prior training of the interpreting pathologist, underlie this finding through their influence on the accuracy of procurement biopsy findings. However, in this study, we found that neither core versus wedge sampling nor the level of renal pathology expertise of the interpreting pathologist was associated with a higher likelihood of accuracy of procurement histology compared to gold-standard reperfusion histology.…”

“…Such findings on a procurement biopsy should raise concerns about the validity of the findings and the biopsy result as a whole. 10 For example, a finding of high glomerulosclerosis but minimal or absent IFTA and vascular disease should prompt suspicion of sampling error. Given the relatively low sample size compared to overall kidney parenchyma inherent in any procurement biopsy, it is not surprising that the impact of increasing glomerular sample size on improving histologic accuracy was modest.…”

Preimplantation Histological Score Associates with 6-Month GFR in Recipients of Perfused, Older Kidney Grafts: Results from a Pilot Study

“…We previously provided solid evidence that a preimplantation histologic score defined based on validated criteria predicts short- and long-term outcomes of kidneys from older/marginal donors preserved with CS [9, 10]. However, this has not been a uniform finding across groups [40, 41], possibly because biopsy scoring has not always been performed by ad hoc trained kidney pathologists on optimally processed samples [39, 42, 43].…”

We listed patients and we should transplant them

“…Biopsy findings are a common reason for kidney turndowns 6 . Biopsy findings are inconsistent when read by on‐call pathologists and not necessarily a reliable indicator of later function or graft survival 8‐10 . When evaluated by trained renal pathologists, showed donor pre‐existing damage was an independent predictor of 12‐month renal function and outcome evaluated by a composite variable including death‐censored graft survival and time to reach an estimated glomerular filtration rate <30 ml/min .…”