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

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.

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A Donor Utilization Index to Assess the Utilization and Discard of Deceased Donor Kidneys Perceived as High Risk

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.02770319 ◽

2019 ◽

Vol 14 (11) ◽

pp. 1634-1641 ◽

Cited By ~ 9

Author(s):

Corey Brennan ◽

Syed Ali Husain ◽

Kristen L. King ◽

Demetra Tsapepas ◽

Lloyd E. Ratner ◽

...

Keyword(s):

High Risk ◽

Regional Variation ◽

Organ Procurement ◽

Deceased Donor ◽

Level Variation ◽

Donor Kidney ◽

Perceptions Of Risk ◽

Deceased Donor Kidney ◽

Number Of Patients ◽

Donor Characteristics

Background and objectivesAn increasing number of patients on the waitlist for a kidney transplant indicates a need to effectively utilize as many deceased donor kidneys as possible while ensuring acceptable outcomes. Assessing regional and center-level organ utilization with regards to discard can reveal regional variation in suboptimal deceased donor kidney acceptance patterns stemming from perceptions of risk.Design, setting, participants, & measurementsWe created a weighted donor utilization index from a logistic regression model using high-risk donor characteristics and discard rates from 113,640 deceased donor kidneys procured for transplant from 2010 to 2016, and used it to examine deceased donor kidney utilization in 182 adult transplant centers with >15 annual deceased donor kidney transplants. Linear regression and correlation were used to analyze differences in donor utilization indexes.ResultsThe donor utilization index was found to significantly vary by Organ Procurement and Transplantation Network region (P<0.001), revealing geographic trends in kidney utilization. When investigating reasons for this disparity, there was no significant correlation between center volume and donor utilization index, but the percentage of deceased donor kidneys imported from other regions was significantly associated with donor utilization for all centers (rho=0.39; P<0.001). This correlation was found to be particularly strong for region 4 (rho=0.83; P=0.001) and region 9 (rho=0.82; P=0.001). Additionally, 25th percentile time to transplant was weakly associated with the donor utilization index (R2=0.15; P=0.03).ConclusionsThere is marked center-level variation in the use of deceased donor kidneys with less desirable characteristics both within and between regions. Broader utilization was significantly associated with shorter time to transplantation.

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Increasing the Donor Pool: Organ Transplantation from Donors with HIV to Recipients with HIV

Annual Review of Medicine ◽

10.1146/annurev-med-060419-122327 ◽

2021 ◽

Vol 72 (1) ◽

pp. 107-118

Author(s):

Puja H. Nambiar ◽

Brianna Doby ◽

Aaron A.R. Tobian ◽

Dorry L. Segev ◽

Christine M. Durand

Keyword(s):

Organ Transplantation ◽

Organ Procurement ◽

Deceased Donor ◽

Scientific Data ◽

Donor Kidney ◽

Donor Pool ◽

New Era ◽

African Experience ◽

Deceased Donor Kidney ◽

Transplant Center

Implementation of the HIV Organ Policy Equity (HOPE) Act marks a new era in transplantation, allowing organ transplantation from HIV+ donors to HIV+ recipients (HIV D+/R+ transplantation). In this review, we discuss major milestones in HIV and transplantation which paved the way for this landmark policy change, including excellent outcomes in HIV D–/R+ recipient transplantation and success in the South African experience of HIV D+/R+ deceased donor kidney transplantation. Under the HOPE Act, from March 2016 to December 2018, there were 56 deceased donors, and 102 organs were transplanted (71 kidneys and 31 livers). In 2019, the first HIV D+/R+ living donor kidney transplants occurred. Reaching the full estimated potential of HIV+ donors will require overcoming challenges at the community, organ procurement organization, and transplant center levels. Multiple clinical trials are ongoing, which will provide clinical and scientific data to further extend the frontiers of knowledge in this field.

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Paediatric deceased donor kidney transplant in Australia: A 30‐year review—What have paediatric bonuses achieved and where to from here?

Pediatric Transplantation ◽

10.1111/petr.14019 ◽

2021 ◽

Author(s):

Matthew P. Sypek ◽

Christopher E. Davies ◽

Amelia K. Le Page ◽

Philip Clayton ◽

Peter D. Hughes ◽

...

Keyword(s):

Kidney Transplant ◽

Deceased Donor ◽

Donor Kidney ◽

Deceased Donor Kidney ◽

Deceased Donor Kidney Transplant

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Left‐digit bias and deceased donor kidney utilization

Clinical Transplantation ◽

10.1111/ctr.14284 ◽

2021 ◽

Author(s):

S. Ali Husain ◽

Kristen L. King ◽

Sumit Mohan

Keyword(s):

Deceased Donor ◽

Donor Kidney ◽

Deceased Donor Kidney

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Association Between Procurement Biopsy Findings and Deceased Donor Kidney Outcomes: A Paired Kidney Analysis

Transplant International ◽

10.1111/tri.13899 ◽

2021 ◽

Author(s):

S. Ali Husain ◽

Kristen L. King ◽

Shana Coley ◽

Karthik Natarajan ◽

Adler Perotte ◽

...

Keyword(s):

Deceased Donor ◽

Donor Kidney ◽

Deceased Donor Kidney

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515 How Has ‘Montgomery’ Changed the Way We Document Risks on Consent Forms for Deceased Donor Kidney Transplantation? A Single-Centre Audit and Re-Audit

British Journal of Surgery ◽

10.1093/bjs/znab134.443 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A M Hussein ◽

C J Callaghan

Keyword(s):

Gold Standard ◽

Deceased Donor ◽

Consent Form ◽

Donor Kidney ◽

Consent Forms ◽

Legal Case ◽

Deceased Donor Kidney ◽

Single Kidney ◽

Donor Kidney Transplantation ◽

Deceased Donor Kidney Transplantation

Abstract Introduction The 2015 Montgomery case changed the remit of risk discussions required during the consent process. This audit reviewed single kidney transplant (SKT) consent forms to establish which risks are documented, and whether this legal case affected discussions. Following the audit, we introduced a pre-printed consent form and closed the audit loop by assessing its uptake. Method Trust paper consent forms for all patients aged 50+ who received a deceased donor SKT in our centre in 2014 (n = 58; pre-Montgomery) and 2017 (n = 70; post-Montgomery) were reviewed to see if 20 perceived ‘gold standard’ risks were documented. A pre-printed procedure-specific consent form including all gold standard risks was then introduced in July 2019. A re-audit reviewed the case-notes of every alternate recipient aged 50+ of a deceased donor SKT from 01/08/19 to 29/02/20 to check if the pre-printed form was used. Results Overall, 53% of the 20 ‘gold standard’ risks were documented in 2014 versus 59% in 2017 (p = 0.55). There was a 91% uptake of the pre-printed consent form. Discussion This audit established the importance of using a pre-printed consent form to standardise risk discussions We propose that pre-printed procedure-specific forms should be encouraged throughout the NHS to support ‘Montgomery-appropriate’ consent discussions.

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