Procurement Biopsies in the Evaluation of Deceased Donor Kidneys
Copyright © 2018 by the American Society of Nephrology..
BACKGROUND AND OBJECTIVES: Biopsies taken at deceased donor kidney procurement continue to be cited as a leading reason for discard; however, the reproducibility and prognostic capability of these biopsies are controversial.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We compiled a retrospective, single-institution, continuous cohort of deceased donor kidney transplants performed from 2006 to 2009. Procurement biopsy information-percentage of glomerulosclerosis, interstitial fibrosis/tubular atrophy, and vascular disease-was obtained from the national transplant database. Using univariable, multivariable, and time-to-event analyses for death-censored graft survival, we compared procurement frozen section biopsy reports with reperfusion paraffin-embedded biopsies read by trained kidney pathologists (n=270). We also examined agreement for sequential procurement biopsies performed on the same kidney (n=116 kidneys).
RESULTS: For kidneys on which more than one procurement biopsy was performed (n=116), category agreement was found in only 64% of cases (κ=0.14). For all kidneys (n=270), correlation between procurement and reperfusion biopsies was poor: overall, biopsies were classified into the same category (optimal versus suboptimal) in only 64% of cases (κ=0.25). This discrepancy was most pronounced when categorizing percentage of glomerulosclerosis, which had 63% agreement (κ=0.15). Interstitial fibrosis/tubular atrophy and vascular disease had agreement rates of 82% (κ=0.13) and 80% (κ=0.15), respectively. Ninety-eight (36%) recipients died, and 56 (21%) allografts failed by the end of follow-up. Reperfusion biopsies were more prognostic than procurement biopsies (hazard ratio for graft failure, 2.02; 95% confidence interval, 1.09 to 3.74 versus hazard ratio for graft failure, 1.30; 95% confidence interval, 0.61 to 2.76), with procurement biopsies not significantly associated with graft failure.
CONCLUSIONS: We found that procurement biopsies are poorly reproducible, do not correlate well with paraffin-embedded reperfusion biopsies, and are not significantly associated with transplant outcomes.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Clinical journal of the American Society of Nephrology : CJASN - 13(2018), 12 vom: 07. Dez., Seite 1876-1885 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Carpenter, Dustin [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 11.12.2019 Date Revised 13.08.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.2215/CJN.04150418 |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Carpenter, Dustin |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Procurement Biopsies in the Evaluation of Deceased Donor Kidneys |
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| 500 | |a Date Completed 11.12.2019 | ||
| 500 | |a Date Revised 13.08.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2018 by the American Society of Nephrology. | ||
| 520 | |a BACKGROUND AND OBJECTIVES: Biopsies taken at deceased donor kidney procurement continue to be cited as a leading reason for discard; however, the reproducibility and prognostic capability of these biopsies are controversial | ||
| 520 | |a DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We compiled a retrospective, single-institution, continuous cohort of deceased donor kidney transplants performed from 2006 to 2009. Procurement biopsy information-percentage of glomerulosclerosis, interstitial fibrosis/tubular atrophy, and vascular disease-was obtained from the national transplant database. Using univariable, multivariable, and time-to-event analyses for death-censored graft survival, we compared procurement frozen section biopsy reports with reperfusion paraffin-embedded biopsies read by trained kidney pathologists (n=270). We also examined agreement for sequential procurement biopsies performed on the same kidney (n=116 kidneys) | ||
| 520 | |a RESULTS: For kidneys on which more than one procurement biopsy was performed (n=116), category agreement was found in only 64% of cases (κ=0.14). For all kidneys (n=270), correlation between procurement and reperfusion biopsies was poor: overall, biopsies were classified into the same category (optimal versus suboptimal) in only 64% of cases (κ=0.25). This discrepancy was most pronounced when categorizing percentage of glomerulosclerosis, which had 63% agreement (κ=0.15). Interstitial fibrosis/tubular atrophy and vascular disease had agreement rates of 82% (κ=0.13) and 80% (κ=0.15), respectively. Ninety-eight (36%) recipients died, and 56 (21%) allografts failed by the end of follow-up. Reperfusion biopsies were more prognostic than procurement biopsies (hazard ratio for graft failure, 2.02; 95% confidence interval, 1.09 to 3.74 versus hazard ratio for graft failure, 1.30; 95% confidence interval, 0.61 to 2.76), with procurement biopsies not significantly associated with graft failure | ||
| 520 | |a CONCLUSIONS: We found that procurement biopsies are poorly reproducible, do not correlate well with paraffin-embedded reperfusion biopsies, and are not significantly associated with transplant outcomes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Research Support, U.S. Gov't, P.H.S. | |
| 650 | 4 | |a Allografts | |
| 650 | 4 | |a Atrophy | |
| 650 | 4 | |a Biopsy | |
| 650 | 4 | |a Follow-Up Studies | |
| 650 | 4 | |a Frozen Sections | |
| 650 | 4 | |a Graft Survival | |
| 650 | 4 | |a Kidney Diseases | |
| 650 | 4 | |a Paraffin Embedding | |
| 650 | 4 | |a Pathologists | |
| 650 | 4 | |a Prognosis | |
| 650 | 4 | |a Reproducibility of Results | |
| 650 | 4 | |a Retrospective Studies | |
| 650 | 4 | |a Tissue Donors | |
| 650 | 4 | |a Vascular Diseases | |
| 650 | 4 | |a kidney | |
| 650 | 4 | |a kidney biopsy | |
| 650 | 4 | |a kidney transplantation | |
| 650 | 4 | |a transplant pathology | |
| 650 | 4 | |a transplantation | |
| 700 | 1 | |a Husain, S Ali |e verfasserin |4 aut | |
| 700 | 1 | |a Brennan, Corey |e verfasserin |4 aut | |
| 700 | 1 | |a Batal, Ibrahim |e verfasserin |4 aut | |
| 700 | 1 | |a Hall, Isaac E |e verfasserin |4 aut | |
| 700 | 1 | |a Santoriello, Dominick |e verfasserin |4 aut | |
| 700 | 1 | |a Rosen, Raphael |e verfasserin |4 aut | |
| 700 | 1 | |a Crew, R John |e verfasserin |4 aut | |
| 700 | 1 | |a Campenot, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Dube, Geoffrey K |e verfasserin |4 aut | |
| 700 | 1 | |a Radhakrishnan, Jai |e verfasserin |4 aut | |
| 700 | 1 | |a Stokes, M Barry |e verfasserin |4 aut | |
| 700 | 1 | |a Sandoval, P Rodrigo |e verfasserin |4 aut | |
| 700 | 1 | |a D'Agati, Vivette |e verfasserin |4 aut | |
| 700 | 1 | |a Cohen, David J |e verfasserin |4 aut | |
| 700 | 1 | |a Ratner, Lloyd E |e verfasserin |4 aut | |
| 700 | 1 | |a Markowitz, Glen |e verfasserin |4 aut | |
| 700 | 1 | |a Mohan, Sumit |e verfasserin |4 aut | |
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