Variations in deceased donor kidney procurement biopsy practice patterns: A survey of U.S. organ procurement organizations

Abstract

Background: Procurement biopsies have become a common practice in the evaluation and allocation of deceased donor kidneys in the United States despite questions about their value and reproducibility. We sought to determine the extent of OPO-level differences in criteria used to decide which deceased donor kidneys undergo a procurement biopsy and to assess the degree of variability in procurement biopsy technique and interpretation across OPOs.Methods: Each of the country's 58 OPOs were invited to participate in the survey.OPOs were divided into two groups based on organ availability ratio and deceased donor kidney discard rate. Results and Conclusions:Fifty-out-of-fifty-eight invited OPOs (86% response rate) responded to the survey between November 2020 and December 2020. Thirty (60%)OPOs reported that they have formal criteria for performing kidney procurement biopsy, but for 29 of these OPOs, transplant centers can request biopsy on kidneys that do not meet criteria. OPOs used a total of seven different variables and 12 different numerical thresholds to define impaired kidney function that would prompt a procurement biopsy. Additionally, wide variability was seen in biopsy technique and procedures for biopsy interpretation and reporting of findings to transplant programs.These findings identify a clear opportunity for standardization of procurement biopsies to best practices. K E Y W O R D Sdeceased donor kidney, kidney biopsy, kidney transplantation, organ procurement organization, organ quality INTRODUCTIONKidney transplant provides better survival and quality of life compared to chronic dialysis for patients with end-stage kidney disease (ESKD), but transplant is limited by the number of kidneys available for trans-

Underscoring the Case for Better Markers of Kidney Injury in Deceased Donors

“…[15][16][17] Despite this, many centers continue to rely extensively on procurement biopsy findings, particularly in instances of an elevated terminal creatinine, purportedly to distinguish AKI from more chronic forms of injury-a practice that is highly variable across the country and one that is without clear evidence that it leads to better organ offer decisions. 9,18 We should note that although the differences in allograft outcomes with kidneys from donors with AKI are statistically significant, even in this analysis they are not meaningfully different from a clinical perspective. This is especially true given that the alternative to using these kidneys is for patients to remain on dialysis, which portends a dramatically lower patient survival-a point that is also made by the authors.…”

Deceased Donor Procurement Biopsy Practices, Interpretation, and Histology-Based Decision-Making: A Survey of US Kidney Transplant Centers

“…As recently surveyed by Emmons et al. 37 OPOs are somewhat more likely to use these criteria as indications for biopsy (63%, 63%, 60%, and 40%, respectively). As the presence of advanced age, diabetes, and hypertension are highly correlated with senescent lesions on the procurement biopsy, 24 , 25 the heterogeneity in practice may result from beliefs of some clinicians that the histologic findings will not add value to the clinical data.…”

The Independent Effects of Procurement Biopsy Findings on 10-Year Outcomes of Extended Criteria Donor Kidney Transplants

“…2 Should the European model of limited reliance on biopsies 15 be universally adopted, or should transplant systems aim to standardize and improve on both the criteria for performing a biopsy 23 and techniques used to obtain, interpret, and share biopsy information? [91][92][93][94][95][96] The goal of both camps is the same: to improve outcomes for patients with end-stage renal failure through timely and successful transplantation.…”