1
|
Stryjak I, Warmuzińska N, Łuczykowski K, Jaroch K, Urbanellis P, Selzner M, Bojko B. Metabolomic and lipidomic landscape of porcine kidney associated with kidney perfusion in heart beating donors and donors after cardiac death. Transl Res 2024; 267:79-90. [PMID: 38052298 DOI: 10.1016/j.trsl.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/23/2023] [Accepted: 12/01/2023] [Indexed: 12/07/2023]
Abstract
Transplant centers are currently facing a lack of tools to ensure adequate evaluation of the quality of the available organs, as well as a significant shortage of kidney donors. Therefore, efforts are being made to facilitate the effective use of available organs and expand the donor pool, particularly with expanded criteria donors. Fulfilling a need, we aim to present an innovative analytical method based on solid-phase microextraction (SPME) - chemical biopsy. In order to track changes affecting the organ throughout the entire transplant procedure, porcine kidneys were subjected to multiple samplings at various time points. The application of small-diameter SPME probes assured the minimal invasiveness of the procedure. Porcine model kidney autotransplantation was executed for the purpose of simulating two types of donor scenarios: donors with a beating heart (HBD) and donors after cardiac death (DCD). All renal grafts were exposed to continuous normothermic ex vivo perfusion. Following metabolomic and lipidomic profiling using high-performance liquid chromatography coupled to a mass spectrometer, we observed differences in the profiles of HBD and DCD kidneys. The alterations were predominantly related to energy and glucose metabolism, and differences in the levels of essential amino acids, purine nucleosides, lysophosphocholines, phosphoethanolamines, and triacylglycerols were noticed. Our results indicate the potential of implementing chemical biopsy in the evaluation of graft quality and monitoring of renal function during perfusion.
Collapse
Affiliation(s)
- Iga Stryjak
- Department of Pharmacodynamics and Molecular Pharmacology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Natalia Warmuzińska
- Department of Pharmacodynamics and Molecular Pharmacology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Kamil Łuczykowski
- Department of Pharmacodynamics and Molecular Pharmacology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Karol Jaroch
- Department of Pharmacodynamics and Molecular Pharmacology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Peter Urbanellis
- Ajmera Transplant Center, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Markus Selzner
- Ajmera Transplant Center, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada; Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - Barbara Bojko
- Department of Pharmacodynamics and Molecular Pharmacology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland.
| |
Collapse
|
2
|
Stewart DE, Foutz J, Kamal L, Weiss S, McGehee HS, Cooper M, Gupta G. The Independent Effects of Procurement Biopsy Findings on Ten-Year Outcomes of Extended Criteria Donor Kidney Transplants. Kidney Int Rep 2022; 7:1850-1865. [PMID: 35967103 PMCID: PMC9366372 DOI: 10.1016/j.ekir.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction Methods Results Conclusion
Collapse
|
3
|
Proteinuria in Deceased Kidney Transplant Donors for Prediction of Chronic Lesions in Pretransplant Biopsies: A Prospective Observational Study. Transplantation 2022; 106:2044-2051. [DOI: 10.1097/tp.0000000000004134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
4
|
A Review of Current and Emerging Trends in Donor Graft-Quality Assessment Techniques. J Clin Med 2022; 11:jcm11030487. [PMID: 35159939 PMCID: PMC8836899 DOI: 10.3390/jcm11030487] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 02/07/2023] Open
Abstract
The number of patients placed on kidney transplant waiting lists is rapidly increasing, resulting in a growing gap between organ demand and the availability of kidneys for transplantation. This organ shortage has forced medical professionals to utilize marginal kidneys from expanded criteria donors (ECD) to broaden the donor pool and shorten wait times for patients with end-stage renal disease. However, recipients of ECD kidney grafts tend to have worse outcomes compared to those receiving organs from standard criteria donors (SCD), specifically increased risks of delayed graft function (DGF) and primary nonfunction incidence. Thus, representative methods for graft-quality assessment are strongly needed, especially for ECDs. Currently, graft-quality evaluation is limited to interpreting the donor’s recent laboratory tests, clinical risk scores, the visual evaluation of the organ, and, in some cases, a biopsy and perfusion parameters. The last few years have seen the emergence of many new technologies designed to examine organ function, including new imaging techniques, transcriptomics, genomics, proteomics, metabolomics, lipidomics, and new solutions in organ perfusion, which has enabled a deeper understanding of the complex mechanisms associated with ischemia-reperfusion injury (IRI), inflammatory process, and graft rejection. This review summarizes and assesses the strengths and weaknesses of current conventional diagnostic methods and a wide range of new potential strategies (from the last five years) with respect to donor graft-quality assessment, the identification of IRI, perfusion control, and the prediction of DGF.
Collapse
|
5
|
Jadav P, Mohan S, Husain SA. Role of deceased donor kidney procurement biopsies in organ allocation. Curr Opin Nephrol Hypertens 2021; 30:571-576. [PMID: 34545039 PMCID: PMC8490331 DOI: 10.1097/mnh.0000000000000746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW There has been an increased emphasis by the transplant community and the federal government to increase the utilization of deceased donor kidneys. Procurement biopsies during allocation are the most common reason for kidney discards. This manuscript reviews the evidence of procurement biopsies practices and utility. RECENT FINDINGS Procurement biopsies are performed in over half of all the kidneys recovered in the United States and account for more than one third of the kidney discards. However, there is a significant heterogeneity across the organ procurement organizations regarding the indications for biopsy, biopsy techniques and their reporting. Procurement biopsy findings are not reproducible and poorly correlate to postimplantation histology, although reasons for these limitations are not clear. Procurement biopsy findings are not associated with posttransplant outcomes after accounting for readily available donor clinical characteristics. SUMMARY Procurement biopsies contribute to deceased donor kidney discards but do not predict posttransplant outcomes. Research to establish the best practices for procurement biopsies is needed to improve organ utilization.
Collapse
Affiliation(s)
- Paresh Jadav
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - S. Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY
| |
Collapse
|
6
|
Carrara C, Ruggenenti P, Remuzzi G. Redefining the Role of Donor Biopsies in the Process of Kidney Graft Assessment. Nephron Clin Pract 2021; 145:728-731. [PMID: 34293750 DOI: 10.1159/000517730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/07/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Camillo Carrara
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,Unit of Nephrology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Piero Ruggenenti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,Unit of Nephrology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| |
Collapse
|
7
|
Kuhn C, Lang BM, Lörcher S, Karolin A, Binet I, Beldi G, Golshayan D, Hadaya K, Mueller TF, Schaub S, Immer F, Stampf S, Koller M, Sidler D. Outcome of kidney transplantation from very senior donors in Switzerland - a national cohort study. Transpl Int 2021; 34:689-699. [PMID: 33529392 DOI: 10.1111/tri.13836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/18/2020] [Accepted: 01/29/2021] [Indexed: 11/29/2022]
Abstract
Kidney transplantation from older and marginal donors is effective to confront organ shortage. However, limitations after transplantation of kidneys from very marginal kidney donors remain unclear. We compared patient and graft outcome, achieved allograft function and quality of life of renal transplantations from Very Senior Donors (VSD, defined as donors aged 70 years and older) with Senior Donors (SD, aged 60-70 years) and Regular Donors (RD, aged younger than 60 years) in Switzerland. We evaluated the outcome of 1554 adult recipients of deceased donor kidney transplantations from 05/2008 to 12/2019; median follow-up was 4.7 years. Failure-free survival (freedom from graft loss or death), glomerular filtration rate (eGFR), and quality of life at 12 months were analyzed for RD (reference group, n = 940), SD (n = 404), and VSD (n = 210). Failure-free survival decreased with increasing donor age, mainly attributable to premature graft loss. Still, overall 5-year failure-free survival reached 83.1%, 81.0%, and 64.0% in the RD, SD, and VSD subgroups, respectively. eGFR 12 months post-transplantation was significantly higher in RD compared with SD and VSD. The acceptance rate of donor candidates for kidney TPL was 78% for the entire cohort (87% for RD, 79% for SD, and 56% for VSD). Deceased donor kidney transplantation from donors aged 70 years or older is associated with an inferior, yet acceptable failure-free outcome, with sustained quality of life.
Collapse
Affiliation(s)
- Christian Kuhn
- Klinik für Nephrologie und Hypertonie, Inselspital, Bern, Switzerland
| | - Brian M Lang
- Klinik für Transplantationsimmunologie und Nephrologie, Universitätsspital Basel, Basel, Switzerland.,Swiss Transplant Cohort Study (STCS), Basel, Switzerland
| | - Sylvia Lörcher
- Klinik für Nephrologie und Hypertonie, Inselspital, Bern, Switzerland
| | - Andrea Karolin
- Klinik für Nephrologie und Hypertonie, Inselspital, Bern, Switzerland
| | - Isabelle Binet
- Klinik für Nephrologie und Transplantationsmedizin, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Guido Beldi
- Klinik für Viszerale Chirurgie und Medizin, Inselspital, Bern, Switzerland
| | - Délaviz Golshayan
- Centre de Transplantation d'organes et Service de Néphrologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Karine Hadaya
- Service de Néphrologie et Hypertension, Hôpitaux Universitaires Genève, Genève, Switzerland
| | - Thomas F Mueller
- Klinik für Nephrologie, Universitätsspital Zürich, Zürich, Switzerland
| | - Stefan Schaub
- Klinik für Transplantationsimmunologie und Nephrologie, Universitätsspital Basel, Basel, Switzerland
| | | | - Susanne Stampf
- Klinik für Transplantationsimmunologie und Nephrologie, Universitätsspital Basel, Basel, Switzerland.,Swiss Transplant Cohort Study (STCS), Basel, Switzerland
| | - Michael Koller
- Klinik für Transplantationsimmunologie und Nephrologie, Universitätsspital Basel, Basel, Switzerland
| | - Daniel Sidler
- Klinik für Nephrologie und Hypertonie, Inselspital, Bern, Switzerland
| |
Collapse
|
8
|
Stewart ZA, Shah SA, Formica RN, Kandaswamy R, Paramesh AS, Friedman J, Squires R, Cooper M, Axelrod DA. A call to action: Feasible strategies to reduce the discard of transplantable kidneys in the United States. Clin Transplant 2020; 34:e13990. [DOI: 10.1111/ctr.13990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Zoe A. Stewart
- Department of Surgery New York University Medical Center New York New York USA
| | - Shimul A. Shah
- Department of Surgery University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Richard N. Formica
- Department of Medicine Yale School of Medicine New Haven Connecticut USA
| | - Raja Kandaswamy
- Department of Surgery University of Minnesota Minneapolis Minnesota USA
| | - Anil S. Paramesh
- Department of Surgery Tulane University School of Medicine New Orleans Louisiana USA
| | - Jessica Friedman
- Department of Surgery Tulane University School of Medicine New Orleans Louisiana USA
| | - Ronald Squires
- Association of Organ Procurement Organizations Vienna Virginia USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute Washington District of Columbia USA
| | - David A. Axelrod
- Department of Surgery School of Medicine University of Iowa Iowa City Iowa USA
| |
Collapse
|
9
|
Ibrahim M, Vece G, Mehew J, Johnson R, Forsythe J, Klassen D, Callaghan C, Stewart D. An international comparison of deceased donor kidney utilization: What can the United States and the United Kingdom learn from each other? Am J Transplant 2020; 20:1309-1322. [PMID: 31758833 DOI: 10.1111/ajt.15719] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/28/2019] [Accepted: 11/15/2019] [Indexed: 01/25/2023]
Abstract
In transplant, meaningful international comparisons in organ utilization are needed. This collaborative study between the United Kingdom (UK) and the United States (US) aimed to develop a kidney utilization metric allowing for legitimate intercountry comparisons. Data from the UK and US transplant registries, including all deceased donor kidneys recovered from 2006 to 2017, were analyzed. To identify a potentially comparable kidney utilization rate (UR), several denominators were assessed. We discovered that the proportion of transplanted kidneys from elderly donors in the UK (10.7%) was 18 times greater than that in the US (0.6%). Conversely, en bloc pediatric kidney transplant was more common in the US. Donation after circulatory death utilization has risen in both countries but is twice as prevalent in the UK (39% of transplants) vs the US (20%). In addition, US and UK URs are not directly comparable due to fundamental system differences. However, using a suite of URs revealed practice areas likely to yield the most benefit if improved, such as efforts to increase kidney offer acceptance in the US and to reduce postacceptance discard in the UK. Methods used in this study, including novel intracountry risk-adjusted UR trend logistic regression analyses, can be translated to other international transplant registries in pursuit of further global learning opportunities.
Collapse
Affiliation(s)
- Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,National Health Service Blood and Transplant, Bristol, UK
| | - Gabe Vece
- United Network for Organ Sharing, Richmond, Virginia
| | - Jenny Mehew
- National Health Service Blood and Transplant, Bristol, UK
| | - Rachel Johnson
- National Health Service Blood and Transplant, Bristol, UK
| | - John Forsythe
- National Health Service Blood and Transplant, Bristol, UK
| | - David Klassen
- United Network for Organ Sharing, Richmond, Virginia
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,National Health Service Blood and Transplant, Bristol, UK
| | | |
Collapse
|
10
|
Husain SA, King KL, Batal I, Dube GK, Hall IE, Brennan C, Stokes MB, Crew RJ, Carpenter D, Alvarado Verduzco H, Rosen R, Coley S, Campenot E, Santoriello D, Perotte A, Natarajan K, D'Agati VD, Cohen DJ, Ratner LE, Markowitz G, Mohan S. Reproducibility of Deceased Donor Kidney Procurement Biopsies. Clin J Am Soc Nephrol 2020; 15:257-264. [PMID: 31974289 PMCID: PMC7015101 DOI: 10.2215/cjn.09170819] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/05/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Unfavorable 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, & MEASUREMENTS We 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. RESULTS Of 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). CONCLUSIONS Deceased 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.
Collapse
Affiliation(s)
- S Ali Husain
- Division of Nephrology, Department of Medicine and .,The Columbia University Renal Epidemiology Group, New York, New York
| | - Kristen L King
- Division of Nephrology, Department of Medicine and.,The Columbia University Renal Epidemiology Group, New York, New York
| | | | | | - Isaac E Hall
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Corey Brennan
- The Columbia University Renal Epidemiology Group, New York, New York.,Kidney and Pancreas Transplant Program, New York Presbyterian Hospital, New York, New York
| | | | - R John Crew
- Division of Nephrology, Department of Medicine and
| | - Dustin Carpenter
- Surgery, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York
| | | | | | | | | | | | - Adler Perotte
- Department of Biomedical Informatics, Columbia University, New York, New York; and
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, New York; and
| | | | | | - Lloyd E Ratner
- Surgery, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York
| | | | - Sumit Mohan
- Division of Nephrology, Department of Medicine and.,The Columbia University Renal Epidemiology Group, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|
11
|
Salvadori M, Tsalouchos A. Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best? World J Transplant 2019; 9:62-80. [PMID: 31523629 PMCID: PMC6715576 DOI: 10.5500/wjt.v9.i4.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/21/2019] [Accepted: 07/30/2019] [Indexed: 02/05/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Maurizio Salvadori
- Department of Transplantation Renal Unit, Careggi University Hospital, viale Pieraccini 18, Florence 50139, Italy
| | - Aris Tsalouchos
- Nephrology and Dialysis Unit, Saints Cosmas and Damian Hospital, Via Cesare Battisti, Pescia (PT) 2-51017, Italy
| |
Collapse
|
12
|
Lentine KL, Naik AS, Schnitzler MA, Randall H, Wellen JR, Kasiske BL, Marklin G, Brockmeier D, Cooper M, Xiao H, Zhang Z, Gaston RS, Rothweiler R, Axelrod DA. Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation. Am J Transplant 2019; 19:2241-2251. [PMID: 30809941 DOI: 10.1111/ajt.15325] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/30/2019] [Accepted: 02/19/2019] [Indexed: 01/25/2023]
Abstract
The use of procurement biopsies in deceased donor kidney acceptance is controversial. We analyzed Scientific Registry of Transplant Recipients data (n = 59 328 allografts, 2014-2018) to describe biopsy practices across US organ procurement organizations (OPOs) and examine relationships with discards, using hierarchical modeling to account for OPO and donor factors. Median odds ratios (MORs) provide the median of the odds that allografts with identical reported traits would be biopsied or discarded from 2 randomly drawn OPOs. Biopsies were obtained for 52.7% of kidneys. Biopsy use rose in a graded manner with kidney donor profile index (KDPI). Biopsy rates differed significantly among OPOs (22.8% to 77.5%), even after adjustment for KDPI and other donor factors. Discard rates also varied from 6.6% to 32.1% across OPOs. After adjustment for donor factors and OPO, biopsy was associated with more than 3 times the likelihood of discard (adjusted odds ratio [95%LCL aOR95%UCL ], 3.29 3.513.76 ). This association was most pronounced for low-risk (KDPI <20) kidneys (aOR, 5.45 6.477.69 ), with minimal impact at KDPI >85 (aOR, 0.88 1.151.51 ). Adjusted MORs for kidney discard and biopsy were greatest for low-risk kidneys. Reducing the rate of unnecessary biopsy and improving the accuracy of histologic assessments in higher KDPI organs may help reduce graft discard rates.
Collapse
Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Abhijit S Naik
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mark A Schnitzler
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Henry Randall
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Jason R Wellen
- Transplant Surgery, Department of Surgery, Washington University, St. Louis, Missouri
| | | | | | | | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington, District of Columbia
| | - Huiling Xiao
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Zidong Zhang
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | | | | | | |
Collapse
|
13
|
Moeckli B, Sun P, Lazeyras F, Morel P, Moll S, Pascual M, Bühler LH. Evaluation of donor kidneys prior to transplantation: an update of current and emerging methods. Transpl Int 2019; 32:459-469. [PMID: 30903673 DOI: 10.1111/tri.13430] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/18/2019] [Indexed: 02/06/2023]
Abstract
The lack of suitable kidney donor organs has led to rising numbers of patients with end stage renal disease waiting for kidney transplantation. Despite decades of clinical experience and research, no evaluation process that can reliably predict the outcome of an organ has yet been established. This review is an overview of current methods and emerging techniques in the field of donor kidney evaluation prior to transplantation. Established techniques like histological evaluation, clinical scores, and machine perfusion systems offer relatively reliable predictions of delayed graft function but are unable to consistently predict graft survival. Emerging techniques including molecular biomarkers, new imaging technologies, and normothermic machine perfusion offer innovative approaches toward a more global evaluation of an organ with better outcome prediction and possibly even identification of targets for therapeutic interventions prior to transplantation. These techniques should be studied in randomized controlled trials to determine whether they can be safely used in routine clinical practice to ultimately reduce the discard rate and improve graft outcomes.
Collapse
Affiliation(s)
- Beat Moeckli
- Department of Surgery and Transplantation, Zurich University Hospital, Zurich, Switzerland
| | - Pamela Sun
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - François Lazeyras
- Department of Radiology and Medical Informatics, CIBM, Geneva University Hospital, Geneva, Switzerland
| | - Philippe Morel
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Solange Moll
- Department of Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Manuel Pascual
- Transplantation Center Lausanne, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Léo H Bühler
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| |
Collapse
|
14
|
Phillips BL, Kassimatis T, Atalar K, Wilkinson H, Kessaris N, Simmonds N, Hilton R, Horsfield C, Callaghan CJ. Chronic histological changes in deceased donor kidneys at implantation do not predict graft survival: a single‐centre retrospective analysis. Transpl Int 2019; 32:523-534. [DOI: 10.1111/tri.13398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/13/2018] [Accepted: 01/04/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Benedict L. Phillips
- Department of Nephrology and Transplantation Guy's and St Thomas’ NHS Foundation Trust London UK
| | - Theodoros Kassimatis
- Department of Nephrology and Transplantation Guy's and St Thomas’ NHS Foundation Trust London UK
| | - Kerem Atalar
- Department of Nephrology and Transplantation Guy's and St Thomas’ NHS Foundation Trust London UK
| | - Hannah Wilkinson
- Department of Nephrology and Transplantation Guy's and St Thomas’ NHS Foundation Trust London UK
| | - Nicos Kessaris
- Department of Nephrology and Transplantation Guy's and St Thomas’ NHS Foundation Trust London UK
| | - Naomi Simmonds
- Department of Histopathology Guy's and St Thomas’ NHS Foundation Trust London UK
| | - Rachel Hilton
- Department of Nephrology and Transplantation Guy's and St Thomas’ NHS Foundation Trust London UK
| | - Catherine Horsfield
- Department of Histopathology Guy's and St Thomas’ NHS Foundation Trust London UK
| | - Chris J. Callaghan
- Department of Nephrology and Transplantation Guy's and St Thomas’ NHS Foundation Trust London UK
| |
Collapse
|
15
|
Carpenter D, Husain SA, Brennan C, Batal I, Hall IE, Santoriello D, Rosen R, Crew RJ, Campenot E, Dube GK, Radhakrishnan J, Stokes MB, Sandoval PR, D’Agati V, Cohen DJ, Ratner LE, Markowitz G, Mohan S. Procurement Biopsies in the Evaluation of Deceased Donor Kidneys. Clin J Am Soc Nephrol 2018; 13:1876-1885. [PMID: 30361336 PMCID: PMC6302333 DOI: 10.2215/cjn.04150418] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 09/07/2018] [Indexed: 11/23/2022]
Abstract
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.
Collapse
Affiliation(s)
| | - S. Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- The Columbia University Renal Epidemiology Group, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Corey Brennan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and
| | | | - Isaac E. Hall
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Dominick Santoriello
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Raphael Rosen
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - R. John Crew
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Geoffrey K. Dube
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | | | - David J. Cohen
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- The Columbia University Renal Epidemiology Group, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and
| |
Collapse
|
16
|
Cooper M, Formica R, Friedewald J, Hirose R, O’Connor K, Mohan S, Schold J, Axelrod D, Pastan S. Report of National Kidney Foundation Consensus Conference to Decrease Kidney Discards. Clin Transplant 2018; 33:e13419. [DOI: 10.1111/ctr.13419] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew Cooper
- Medstar Georgetown Transplant Institute; Georgetown University; Washington District of Columbia
| | - Richard Formica
- Department of Medicine, Section of Nephrology; Yale School of Medicine; New Haven Connecticut
| | - John Friedewald
- Northwestern University Comprehensive Transplant Center; Chicago Illinois
| | - Ryutaro Hirose
- Department of Surgery; University of California San Francisco; San Francisco California
| | | | - Sumit Mohan
- Division of Nephrology, Department of Medicine; Vagelos College of Physicians & Surgeons, Columbia University; New York New York
- Department of Epidemiology, Mailman School of Public Health; Columbia University; New York New York
| | - Jesse Schold
- Department of Quantitative Health Sciences; Cleveland Clinic; Cleveland Ohio
| | - David Axelrod
- Department of Surgery; Lahey Hospital and Medical Center; Burlington Massachusetts
| | - Stephen Pastan
- Renal Division, Department of Medicine; Emory University School of Medicine; Atlanta Georgia
| |
Collapse
|
17
|
Does the Kidney Donor Profile Index (KDPI) predict graft and patient survival in a Spanish population? Nefrologia 2018; 38:587-595. [PMID: 30243494 DOI: 10.1016/j.nefro.2018.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/23/2018] [Accepted: 06/16/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The Kidney Donor Profile Index (KDPI), together with other donor and recipient variables, can optimise the organ allocation process. This study aims to check the feasibility of the KDPI for a Spanish population and its predictive ability of graft and patient survival. MATERIALS AND METHODS Data from 2,734 kidney transplants carried out in Andalusia between January 2006 and December 2015 were studied. Cases were grouped by recipient age, categorised by KDPI quartile and both graft and patient survival were compared among groups. RESULTS The KDPI accurately discriminated optimal organs from suboptimal or marginal ones. For adult recipients (aged: 18-59years) it presents a hazard ratio of 1.013 (P<.001) for death-censored graft survival and of 1.013 (P=.007) for patient survival. For elderly recipients (aged: 60+years), KDPI presented a hazard ratio of 1.016 (P=.001) for death-censored graft survival and of 1.011 (P=.007) for patient survival. A multivariate analysis identified the KDPI, donor age, donation after circulatory death, recipient age and gender as predictive factors of graft survival. CONCLUSIONS The results obtained show that the KDPI makes it possible to relate the donor's characteristics with the greater or lesser survival of the graft and the patient in the Spanish population. However, due to certain limitations, a new index for Spain based on Spanish or European data should be created. In this study, some predictive factors of graft survival are identified that may serve as a first step in this path.
Collapse
|
18
|
Hall IE, Parikh CR, Schröppel B, Weng FL, Jia Y, Thiessen-Philbrook H, Reese PP, Doshi MD. Procurement Biopsy Findings Versus Kidney Donor Risk Index for Predicting Renal Allograft Survival. Transplant Direct 2018; 4:e373. [PMID: 30255133 PMCID: PMC6092182 DOI: 10.1097/txd.0000000000000816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/18/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Efforts to maximize transplantation by matching organ quality to recipient longevity require reliable tools. The US kidney allocation system uses the Kidney Donor Risk Index (KDRI) for this purpose, and many centers additionally rely on donor biopsies. The Leuven score combines donor age with procurement histology (glomerulosclerosis and interstitial fibrosis/tubular atrophy) to predict allograft survival. METHODS We compared KDRI with Leuven scores for associations with kidney discard, delayed graft function, and allograft function and survival. We used Cox, modified Poisson, and linear regression to calculate risks based on KDRI and (separately) Leuven scores, adjusting for important transplant and recipient variables. RESULTS From 890 donors, 1729 kidneys were procured and biopsied. Five hundred eighty-five (34%) kidneys were discarded. Median donor age was 53 years (interquartile range [IQR], 44-61 years). Median KDRI and Leuven scores were 1.56 (IQR, 1.28-1.90) and 59 (IQR, 49-69). Relative risk for discard was 1.21 (95% confidence interval [CI], 1.17-1.24) per 0.2-unit increase in KDRI and 1.38 (1.31-1.46) per 10-unit increase in Leuven score. Adjusted relative risks for delayed graft function were 0.98 (95% CI, 0.94-1.02) and 0.94 (95% CI, 0.90-0.99), adjusted hazard ratios for graft failure were 1.10 (95% CI, 1.04-1.16) and 1.11 (95% CI, 1.02-1.21), and adjusted linear regression coefficients for 3-year estimated glomerular filtration rate were -3.88 (-4.63 to -3.13) and -5.18 (-6.19 to -4.18). CONCLUSIONS In kidneys clinically selected for procurement biopsy, the Leuven score was more strongly associated with discard but performed similarly to KDRI for predicting transplant outcomes, suggesting the need to reevaluate current procurement biopsy practices. Given modest associations for both tools; however, neither KDRI nor the Leuven score should be used in isolation for individual organ acceptance decisions.
Collapse
Affiliation(s)
- Isaac E. Hall
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Chirag R. Parikh
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT
- Veterans Affairs Connecticut Healthcare System, New Haven, CT
| | | | | | - Yaqi Jia
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT
| | | | - Peter P. Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA
| | - Mona D. Doshi
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| |
Collapse
|
19
|
Miret Alomar E, Trilla Herrera E, Lorente Garcia D, Regis Placido L, López del Campo R, Cuadras Solé M, Pont Castellana T, Moreso Mateos F, Serón Micas D, Morote Robles J. Systematic review of kidney transplantation functional predictors. Actas Urol Esp 2018; 42:218-226. [PMID: 28803679 DOI: 10.1016/j.acuro.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 01/23/2023]
Abstract
CONTEXT Kidney transplantation from donors with expanded criteria has increased the pool of kidneys at the cost of a higher risk of short and long-term graft dysfunction. The main issue lies in determining which kidneys will offer acceptable function and survival compared with the risk represented by surgery and subsequent immunosuppression. OBJECTIVE The objective of our article is to review the current evidence on the tools for predicting the functionality of kidney transplantation from cadaveric donors with expanded criteria and determining the validity for their use in standard practice. ACQUISITION OF EVIDENCE We conducted a systematic literature review according to the PRISM criteria, through Medline (http://www.ncbi.nlm.nih.gov) and using the keywords (in isolation or in conjunction) "cadaveric renal transplantation; kidney graft function appraisal, graft function predictors". We selected prospective and retrospective series and review articles. A total of 375 articles were analysed, 39 of which were ultimately selected for review. SUMMARY OF THE EVIDENCE The predictors of functionality include the following: The donor risk indices; the calculation of the renal functional weight or the assessment of the nephronic mass; the measurement of vascular resistances during perfusion in hypothermia; the measurement of the donor's biomarkers in urine and in the perfusion liquid; the measurement of functional and reperfusion parameters in normothermia; and the measurement of morphological parameters (microscopic and macroscopic) of the target organ. In this article, we present an explanatory summary of each of these parameters, as well as their most recent evidence on this issue. DISCUSSION None of the reviewed parameters in isolation could reliably predict renal function and graft survival. There is a significant void in terms of the macroscopic assessment of kidney transplantation. CONCLUSIONS We need to continue developing predictors of renal functionality to accurately define the distribution of each currently available donor kidney.
Collapse
|
20
|
Osband AJ, Fyfe B, Laskow DA. Virtual microscopy improves sharing of deceased donor kidneys. Am J Surg 2016; 212:592-595. [DOI: 10.1016/j.amjsurg.2016.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/28/2016] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
|
21
|
Yong ZZ, Kipgen D, Aitken EL, Khan KH, Kingsmore DB. Wedge Versus Core Biopsy at Time Zero: Which Provides Better Predictive Value for Delayed Graft Function With the Remuzzi Histological Scoring System? Transplant Proc 2016; 47:1605-9. [PMID: 26293021 DOI: 10.1016/j.transproceed.2015.03.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 03/04/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Histopathological features on time-zero renal biopsies correlate with graft outcome after renal transplantation. With increasing numbers of marginal donors, assessment of pre-implantation graft quality is essential. The clinician's choice of wedge or core biopsy is performed without evidence of efficacy or safety. This study aims to compare the information derived from wedge biopsy versus core biopsy. METHODS Prospective evaluation of 37 wedge biopsies and 30 core biopsies was performed. Histopathological data were collected on number of glomeruli and arterioles observed, and Remuzzi scoring for glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arteriolar narrowing was performed. Clinical data on delayed graft function (DGF) were also collated. Sensitivity, specificity, and positive and negative predictive values for DGF were compared. RESULTS Patient demographics between the two cohorts were comparable. No complications of biopsies occurred; 81% of wedge biopsies versus 50% of core biopsies had >10 glomeruli (P = .01), whereas 32% of wedge biopsies and 57% of core biopsies had >2 arterioles (P = .02). Wedge biopsies were more likely to identify pathology with more glomerulosclerosis, tubular atrophy (P < .01), and interstitial fibrosis (P < .01). There was a non-significant trend toward high Remuzzi scores in wedge biopsy (22% versus 7% with Remuzzi ≥ 4; P = .12). The sensitivity and positive predictive value of Remuzzi ≥ 4 for predicting DGF was better on wedge biopsy (45.5% versus 0%; P < .01 and 62.5% versus 0%; P < .01, respectively). CONCLUSIONS Wedge biopsies were safe and superior to core biopsies for identifying clinically significant histopathological findings on pre-implantation renal biopsy. We believe that the wedge biopsy is the method of choice for time-zero biopsies.
Collapse
Affiliation(s)
- Z Z Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | - E L Aitken
- Renal Transplant Unit, Western Infirmary, Glasgow, Scotland, United Kingdom
| | - K H Khan
- Renal Transplant Unit, Western Infirmary, Glasgow, Scotland, United Kingdom
| | - D B Kingsmore
- Renal Transplant Unit, Western Infirmary, Glasgow, Scotland, United Kingdom
| |
Collapse
|
22
|
Pisarski P, Schleicher C, Hauser I, Becker JU. German recommendations for pretransplantation donor kidney biopsies. Langenbecks Arch Surg 2016; 401:133-40. [PMID: 26994917 DOI: 10.1007/s00423-016-1384-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/12/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE This manuscript reviews the data about the histopathologic and develops recommendations to standardise and improve the biopsy procedure, the biopsy handling, the histopathological evaluation, the communication of results and the collection of data from pretransplantation kidney biopsies of deceased donors in Germany. METHODS The recommendations are based on this literature review, on discussions at two workshops held by the German Society of Pathology and the German Organ Transplantation Foundation and on personal experiences of the authors. RESULTS These German recommendations advocate the use of punch biopsies, paraffin embedding and detailed descriptive reporting of histopathological findings. CONCLUSIONS These recommendations constitute only a starting point. Periodical revisions will help to simplify and optimise the recommendations with the ultimate goal to prospectively gather data for the elaboration of a computer-based algorithm that allows the exact prediction of transplantation outcome for a given match of donor and recipient.
Collapse
Affiliation(s)
- Przemyslav Pisarski
- Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany
| | | | - Ingeborg Hauser
- Medical Clinic III, Nephrology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jan U Becker
- Institute of Pathology, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| |
Collapse
|
23
|
Valor pronóstico de la biopsia renal preimplante en donantes fallecidos de edad avanzada en la función renal al año del trasplante. Nefrologia 2016; 36:33-41. [DOI: 10.1016/j.nefro.2015.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/10/2015] [Indexed: 11/21/2022] Open
|
24
|
High-Resolution Imaging Using the VisualSonics Vevo 2100 on Isolated, Perfused Porcine Kidneys on Mechanical Circulatory Support. ASAIO J 2015; 60:473-8. [PMID: 24814832 DOI: 10.1097/mat.0000000000000092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite many improvements in the field of renal transplantation, the key problem that persists is the lack of organs for all the patients who need kidneys. This problem continues despite the addition of extended criteria donors and donation after cardiac death. Compounding this issue is the high discard rate and there are no good means to truly predict renal function using current pretransplantation testing parameters. In an isolated renal perfusion model using porcine kidneys, we tested the proof of principle that a Vevo 2100 high-frequency high-resolution ultrasound system (Fujifilm VisualSonics, Inc., Toronto, Canada) could assess renal parenchymal perfusion and flow in the central renal vessels which could not assess by conventional ultrasound. Images and velocities were easily obtained during these studies. High-frequency ultrasound imaging may be a feasible and reproducible method for assessing renal parenchymal integrity and function pretransplantation. Further studies are required to determine the sensitivity and specificity of this approach in comparison with traditional renal biopsy pretransplantation with the goal of increasing the identification and use of donated kidneys for transplantation.
Collapse
|
25
|
Tavares da Silva E, Oliveira R, Castelo D, Marques V, Sousa V, Moreira P, Simões P, Bastos CA, Figueiredo A, Mota A. Pretransplant biopsy in expanded criteria donors: do we really need it? Transplant Proc 2015; 46:3330-4. [PMID: 25498046 DOI: 10.1016/j.transproceed.2014.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Renal transplantation is the best treatment for end-stage renal disease, including when using expanded criteria donors (ECD) kidneys. However, these suboptimal kidneys should be evaluated rigorously to meet their usefulness. Opinions differ about the best way to evaluate them. MATERIALS AND METHODS We retrospectively reviewed kidneys from ECD harvested by a single academic institution between January 2008 and September 2013. Needle biopsies were performed at the time of the harvest when considered relevant by the transplant team. Two pathologists where responsible for their analysis; the Remuzzi classification has been used in all cases. RESULTS We evaluated 560 ECD kidneys. Biopsies were made in 197 (35.2%) organs, 20 of which were considered not usable and 36 good only for double transplantation. Sixty-three kidneys (11.3%) were discarded by the transplant team based on the biopsy result and clinical criteria. Donors who underwent a biopsy were older (P < .001) and had a worse glomerular filtration rate (GFR; P = .001). Comparing donors approved and rejected by the biopsy, the rejected donors were heavier (P = .003) and had a lower GFR (P = .002). Cold ischemia time was longer for the biopsy group (P < .001). Regarding graft function, the biopsy overall score correlated with the transplant outcome in the short and long term. Separately, glomeruli and interstitium scores were correlated with recipient's GFR in the earlier periods (3 months; P = .025 and .037), and the arteries and tubules correlated with GFR in the longer term (at 3 years P = .004 and .010). CONCLUSION The decision on the usability of ECD grafts is complex. At our center, we chose a mixed approach based on donor risk. Low-risk ECD do not require biopsy. In more complex situations, especially older donors or those with a lower GFR, prompted a pretransplant biopsy. The biopsy results proved to be useful as they relate to subsequent transplant outcomes, thereby allowing us to exclude grafts whose function would most probably be less than optimal.
Collapse
Affiliation(s)
- E Tavares da Silva
- Urology and Renal Transplantation Department, Coimbra's Hospital and University Center, Coimbra, Portugal.
| | - R Oliveira
- Pathology Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| | - D Castelo
- Urology and Renal Transplantation Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| | - V Marques
- Urology and Renal Transplantation Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| | - V Sousa
- Pathology Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| | - P Moreira
- Pathology Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| | - P Simões
- Urology and Renal Transplantation Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| | - C A Bastos
- Pathology Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| | - A Figueiredo
- Urology and Renal Transplantation Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| | - A Mota
- Urology and Renal Transplantation Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| |
Collapse
|
26
|
Wang CJ, Wetmore JB, Crary GS, Kasiske BL. The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review. Am J Transplant 2015; 15:1903-14. [PMID: 25772854 DOI: 10.1111/ajt.13213] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 01/25/2023]
Abstract
Despite a growing organ shortage in the United States, many deceased donor kidneys removed for transplantation are discarded. Kidney biopsy findings often play a role in these discards, although it is not clear whether biopsies reliably inform acceptance decisions. Therefore, we carried out a systematic review of the medical literature on the utility of both procurement and implantation biopsies for predicting posttransplant outcomes. Between January 1, 1994 and July 1, 2014, 47 studies were published in the English language literature that examined the association between pretransplant donor biopsy findings from 50 or more donors (with more than half being from deceased donors) and either posttransplant graft failure, delayed graft function, or graft function. In general, study quality was poor. All were retrospective or did not indicate if they were prospective. Results were heterogeneous, with authors as often as not concluding that biopsy results did not predict posttransplant outcomes. The percent glomerular sclerosis was most often examined, and failed to predict graft failure in 7 of 14 studies. Of 15 semiquantitative scoring systems proposed, none consistently predicted posttransplant outcomes across studies. Routine use of biopsies to help determine whether or not to transplant a kidney should be reexamined.
Collapse
Affiliation(s)
- C J Wang
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - J B Wetmore
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - G S Crary
- Department of Pathology, Hennepin County Medical Center, Minneapolis, MN
| | - B L Kasiske
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| |
Collapse
|
27
|
Abstract
In patients with end-stage renal disease, kidney transplantation is the best means to extend survival and offer a better quality of life. The current shortage of organs available for transplantation has led to an effort to expand the kidney donor pool, including the use of nonideal donor kidneys. Assessment of the quality of the donated kidney is essential, and would facilitate the decision to transplant a potential organ or discard it. Multiple clinical and histologic parameters have been examined to evaluate the donor kidney and relate the findings to the graft outcome, but clear-cut criteria are yet to be defined.
Collapse
Affiliation(s)
- Nasreen Mohamed
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Amer Bin Thabet Street-mbc035, PO Box 15215, Dammam 31444, Kingdom of Saudi Arabia
| | - Lynn D Cornell
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
28
|
Kasiske BL, Stewart DE, Bista BR, Salkowski N, Snyder JJ, Israni AK, Crary GS, Rosendale JD, Matas AJ, Delmonico FL. The role of procurement biopsies in acceptance decisions for kidneys retrieved for transplant. Clin J Am Soc Nephrol 2014; 9:562-71. [PMID: 24558053 DOI: 10.2215/cjn.07610713] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES There is a shortage of kidneys for transplant, and many patients on the deceased donor kidney transplant waiting list would likely benefit from kidneys that are currently being discarded. In the United States, the most common reason given for discarding kidneys retrieved for transplant is procurement biopsy results. This study aimed to compare biopsy results from discarded kidneys with discard attributed to biopsy findings, with biopsy results from comparable kidneys that were successfully transplanted. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this retrospective, observational, case-control study, biopsy reports were examined from 83 kidneys discarded in 2010 due to biopsy findings (cases), 83 contralateral transplanted kidneys from the same donor (contralateral controls), and 83 deceased donors randomly matched to cases by donor risk profile (randomly matched controls). A second procurement biopsy was obtained in 64 of 332 kidneys (19.3%). RESULTS The quality of biopsy reports was low, with amounts of tubular atrophy, interstitial inflammation, arteriolar hyalinosis, and acute tubular necrosis often not indicated; 69% were wedge biopsies and 94% used frozen tissue. The correlation between first and second procurement biopsies was poor; only 25% of the variability (R(2)) in glomerulosclerosis was explained by biopsies being from the same kidney. The percentages of glomerulosclerosis overlapped substantially between cases, contralateral controls, and randomly matched controls: 17.1%±15.3%, 9.0%±6.6%, and 5.0%±5.9%, respectively. Of all biopsy findings, only glomerulosclerosis>20% was independently correlated with discard (cases versus contralateral controls; odds ratio, 15.09; 95% confidence interval, 2.47 to 92.41; P=0.003), suggesting that only this biopsy result was used in acceptance decisions. One-year graft survival was 79.5% and 90.7% in contralateral and randomly matched controls, respectively, versus 91.6% among all deceased donor transplants in the Scientific Registry of Transplant Recipients. CONCLUSIONS Routine use of biopsies could lead to unnecessary kidney discards.
Collapse
Affiliation(s)
- Bertram L Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota;, †Department of Medicine and, ¶Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, Minneapolis, Minnesota;, ‡Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, Virginia;, §Departments of Medicine and, *Surgery, and, ‖Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, ††New England Organ Bank, Waltham, Massachusetts
| | | | | | | | | | | | | | | | | | | |
Collapse
|