The Prognostic Utility of Deceased Donor Implantation Biopsy in Determining Function and Graft Survival After Kidney Transplantation

Cockfield, Sandra M.; Moore, Ronald B.; Todd, Gerald; Solez, Kim; Gourishankar, Sita

doi:10.1097/tp.0b013e3181ca7e9b

Cited by 62 publications

(66 citation statements)

References 42 publications

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“…Though in many cases renal biopsy at the time of recovery assumes critical importance in discriminating for acceptance of suboptimal donors [24,25], this procedure holds some disadvantages to be taken into account, primarily the lengthening of transplant procedure time and the exposure of the organ to bleeding risk especially in the presence of chronic organ degeneration. For this reason we sought to establish ex-post if the application of Nyberg’s clinical score had disclosed substantial differences in terms of organ allocation and transplant outcome.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Three-Year Outcome of Renal Transplantation from Optimal Donors versus Expanded Criteria Donors

Manna¹,

Comai²,

Cappuccilli³

et al. 2013

Am J Nephrol

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Background/Aims: The shortage in organ supply has required the use of expanded criteria donors (ECD) for kidney transplantation. Current pre-transplant evaluations of ECD organs are based on histological, clinical or mixed criteria. This monocentric study investigates the predictivity of Karpinski’s histological score on 3-year graft function in renal transplant. Ex-post classification using Nyberg’s score was carried out to assess the reliability of a purely clinical score and its applicability for organ allocation. Methods: We evaluated 407 deceased donors (251 optimal and 156 ECD) for renal transplants performed between 2001 and 2006. The differences in creatinine levels and MDRD-GFR at transplant and 1, 2 and 3 years post-transplant between optimal donors and ECD were recorded. Amongst ECD organs, the effect of different Karpinski score classes (0–1, 2, 3, 4, double transplants) on 3-year graft outcomes was analyzed. We then compared renal function over time across the Nyberg grades (A, B, C, and D). Results: Karpinski scores 0–1 and 2 and double transplants were associated with improved graft function compared to scores 3 and 4. Nyberg’s clinical score shows a good fit with medium-term outcome and Karpinski’s score, but among the donors with a high Nyberg grade (C and D), it fails to differentiate between allocable or non-allocable organs (due to Karpinski’s score ≥7). Conclusions: Our data demonstrate a correlation of histological damage at the time of transplant with 3-year graft function, but at present we are unable to provide any supposition on the possible outcome of the discarded kidneys.

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Section: Discussionmentioning

confidence: 99%

Prediction of Three-Year Outcome of Renal Transplantation from Optimal Donors versus Expanded Criteria Donors

Manna¹,

Comai²,

Cappuccilli³

et al. 2013

Am J Nephrol

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“…8 However, the study by Kahu et al clearly shows that more advanced histologic lesions have a greater impact on graft survival in grafts from donors with four or more risk factors than in those from donors with three or fewer risk factors. Questions remain, however, regarding the applic ability of their findings in the clinical setting.…”

Section: Edmund Huang Gabriel Danovitch and Suphamai Bunnapradistmentioning

confidence: 96%

“…Other parameters, such as vascular lesions, may be more predictive of graft survival than is glomerulosclerosis. 8 The CADI score utilized by Kahu and colleagues incorporates multiple histologic parameters and associates with graft survival in grafts with a higher donor risk score (>3), but not in those with a donor score of ≤3.…”

Section: Edmund Huang Gabriel Danovitch and Suphamai Bunnapradistmentioning

confidence: 99%

Donor risk scores: can they predict renal transplant outcomes?

2011

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“…19 Most investigators agree that glomerulosclerosis alone is limited in its overall predictive value. 20 Other studies have emphasized donor vascular disease as the most important histologic predictor of graft function, 20 but evaluation of vessels may be affected by biopsy technique. Some studies have shown that wedge biopsies underestimate the amount of arterial sclerosis compared with core biopsies.…”

Section: Preimplantation Donor Biopsy Evaluationmentioning

confidence: 99%

Frozen Section Evaluation of Preimplantation Donor Kidneys

Huebner

Papadimitriou

Gonzalez

et al. 2010

Pathology Case Reviews

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The benefits of renal transplantation for patients with endstage renal disease on hemodialysis are well established, but currently there is a significant shortage of organs available for transplantation. In an effort to increase the size of the donor pool, donors that may have been excluded from donating previously are currently accepted. Frozen section evaluation of preimplantation donor kidney biopsies is particularly important for organs from these expanded criteria donors, both to determine organ suitability and as a tool to predict short-and long-term graft survival. Although significant progress has been made in the field, controversy still remains regarding the predictive value of the individual pathologic parameters to predict graft outcome. The Maryland Aggregate Pathology Index score is based on the identification of 5 histologic parameters and is used to stratify donor organs into low-, intermediate-, and high-risk groups, which correlate with overall graft survival. Irrespectively of the transplant donor population, preimplantation donor kidney frozen section evaluation is an invaluable tool for optimal use of the available organs.A 62-year-old white woman with a 15-year history of type 2 diabetes mellitus, obesity, and hypertension was admitted for an ischemic cerebral stroke and ultimately died despite appropriate medical treatment. After discussion with the family, it became clear that the patient wished to be an organ donor, and both kidneys were harvested for further evaluation. During the course of the disease, the patient had a good renal function with a terminal serum creatinine level of 1.5 mg/dL. On the basis of the clinical information, the patient was categorized as an expanded criteria donor (ECD; refer to the next sections). Pathologic EvaluationWedge biopsies of each kidney were submitted for frozen section preimplantation analysis. The biopsies measured a mean of 1.4 Â 0.8 Â 0.4 cm. The specimens were blotted dry and snap frozen in liquid nitrogen. Routinely prepared 5-Km-thick sections, stained with hematoxylin and eosin, were evaluated.Global evaluation of the frozen sections at low magnification demonstrated preserved renal cortex with an adequate number of glomeruli (mean, 62 per section). Similar findings were observed in the left and right kidneys, with global glomerular sclerosis of 17% and 20%, respectively. There were small scattered areas of tubulointerstitial atrophy (scarring) that affected up to 15% of the overall cortical surface.Two to 4 interlobular arteries were present in each section, and in the most affected arteries, there was moderate narrowing due to arteriosclerosis (wall-to-lumen ratios [WLRs], Q0.5). Many arterioles (glomerular-size, preglomerular) had thickening of their walls due to hyalinosis.

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The Prognostic Utility of Deceased Donor Implantation Biopsy in Determining Function and Graft Survival After Kidney Transplantation

Abstract: Therefore, although biopsy evidences of vascular pathologic condition, kidney may contribute meaningfully to the assessment of donor quality but the degree of GS does not.

Cited by 62 publications

References 42 publications

Prediction of Three-Year Outcome of Renal Transplantation from Optimal Donors versus Expanded Criteria Donors

Prediction of Three-Year Outcome of Renal Transplantation from Optimal Donors versus Expanded Criteria Donors

Donor risk scores: can they predict renal transplant outcomes?

Frozen Section Evaluation of Preimplantation Donor Kidneys

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